V 


The  fundamental  purpose  of  labor  legislation  is  the  con- 
servation of  the  human  resources  of  the  nation. 


AMERICAN     LABOR     LEGISLATION 


VOT    II,  No.  2 
PUBLICATION  17 


REVIEW 


ISSUED  Qu, 
PRICE  $3.00  Pi 


INDUSTRIAL  DISEASES 


Symposium  on  Diseases  of  Occupation. 
Investigation  of  Industrial  Diseases. 
Health  Problems  in  Modern  Industry. 
State  Promotion  of  Industrial  Hygiene. 
Bibliography  on  Industrial  Diseases. 


JUNE,    1912 

PROCEEDINGS   OF  THE  SECOND  NATIONAL  CONFERENCE  ON  INDUSTRIAL  DISEASES 
ATLANTIC 'CITY,  N.  J.,  JUNE  3~5,   IQI2 

American  Association  for  Labor  Legislation 
Joint  Session  with  American  Medical  Association 

AMERICAN    ASSOCIATION    FOR    LABOR    LEGISLATION 
131  EAST  23d  ST.,  NEW  YORK  CITY 

Entered  as  second-class  matter  February  20, 1911,  at  the  post  office  at  New  York,  N.  YM 
under  the  Act  of  July  16, 1894 

PRICE    ONE    DOLLAR 


American  Association  for  Labor  Legislation 

131  EAST  23d  ST.,  NEW  YORK  CITY 

President,  HENRY  R.   SEAGER,   Columbia   University. 

Vice-Presidents 

JANE  ADDA  MS,   Chicago  MORTON  D.  HULL,  Chicago. 

Louis  D.  BRANDEIS,  Boston,  Mass.  J.  W.  JENKS,  Ithaca,  N.  Y. 

ROBERT   W.   DEFOREST,    New    York  FREDERICK  N.  JUDSON,  St.  Louis 

RICHARD  T.  ELY,  Madison,  Wis.  PAUL  M.  WARBURG,  New  York 

SAMUEL  GOMPERS,  Washington,  D.  C.  WOODROW  WILSON,  Trenton,  N.  J. 

Secretary,  JOHN  B.  ANDREWS,   131  East  23d   St.,  New  York. 
Assistant  Secretary,  IRENE  OSGOOD  ANDREWS,  New  York  City. 
Treasurer,  V.  EVERIT  MACY,  New  York  City. 

EXECUTIVE  COMMITTEE 

CHARLES  M.  CABOT,  Boston  FREDERICK  L.  HOFFMAN,  Newark 

JOHN  CALDER,  Detroit,  Mich.  PAUL  U.  KELLOGG,  New  York  City 

JOHN  R.  COMMONS,  Madison,  Wis.  SAMUEL  McC.  LINDSAY,  New  York 

HENRY  W.  FARNAM,  New  Haven  JOHN  MITCHELL,  New  York  City 

ERNST  FREUND,  Chicago  CHARLES  P.  NEILL,  Washington 
The  President  and  the  Secretary. 

MEMBERSHIP  AND  DUES 
Minimum  individual  membership  fee,  $3  a  year. 
Associate  members  contribute  annually  $5  to  $25. 
Contributing  members  contribute  annually  $25  to  $100. 
Sustaining  members  contribute  annually  $100  or  more. 
In  addition  to  the  American  Labor  Legislation  Review,  which  is  sent  pre- 
paid to  all  members,  the  quarterly  \Bulletin  of  the  International  Labor  Office 
will  be  sent  to  members  paying  $5  or  more,  if  specially  requested. 
Societies  and  institutions  pay  $5  or  more  a  year  and  receive  all  publications. 
Letters  of  inquiry  and  membership  contributions  should  be  sent  to  THE 
AMERICAN  ASSOCIATION  FOR  LABOR  LEGISLATION,  JOHN  B.  ANDREWS,  Secretary, 
131  East  23d  St.,  New  York  City. 


International  Association  for  Labor  Legislation 

BASEL,  SWITZERLAND. 

Serves  as  a  bond  of  union  to  all  who  believe  in  the  necessity  for  Labor 
Legislation. 

Facilitates  the  study  of  Labor  Legislation  in  all  countries  and  provides  in- 
formation on  the  subject. 


The  International  Labor  Office  publishes  a  periodical  Bulletin  in  English, 
German  and  French — which  contains  the  text  of  recent  Labor  Laws  in  all 
countries,  notes  on  action  taken  in  the  various  Legislatures,  resolutions  of 
Congresses,  and  an  International  Bibliography  on  Labor  Legislation. 


NATIONAL    SECTIONS 

ARGENTINA  FINLAND  ITALY 

AUSTRIA  FRANCE  NORWAY 

BELGIUM  GERMANY  SPAIN 

DENMARK  HOLLAND  SWEDEN 

ENGLAND  HUNGARY  SWITZERLAND 

UNITED  STATES 


^ 


141 


AMERICAN  LABOR  LEGISLATION  REVIEW 
Vol.  II,   No.   2 


t '. 

•  \: 


ILLUSTRATIONS 

Dry  Sandpapering.  Wet  Sanding  with  Pumice  Stone. Facing  Page  181 

Arsenic  Poisoning 188 

Cross  Section  of  Caisson  in  Full  Operation 193 

Occupational  Skin  Diseases "            "      208 

Making  Lead  Colors.     Lead  Casting,  Showing  Lead 

Pot  in  a  Smelter 273 

Dust  Collectors  in  a  Lead  Plant.     Emptying  a  Red- 
Lead  Furnace    ', 277 

Lead    Used    as    a   Hardening   Agent.      Heading    up 

Barrels  of  Dry  Red  Lead "                   284 

Chaser  Room  in  White-Lead  Factory   "            "      288 

Air-Lock  on  Top  of  Caisson "            "      353 

Separating  Screens  in  White-Lead  Factory 360 

Workers  in  White-Lead  Factory "            "      368 


AMERICAN  LABOR  LEGISLATION 

REVIEW 

Vol.  II  JUNE,  1912  No.  2 

CONTENTS 

I.     SYMPOSIUM  ON  INDUSTRIAL  DISEASES.  PAGE 

Classification  of  Occupational  Diseases W.  G.  THOMPSON...   185 

Compressed- Air    Illness FREDERICK  L.   KEAYS  192 

Occupational   Skin   Diseases , JOHN    A.    FORDYCE.  .  206 

Occupational  Nervous  and  Mental  Diseases .. CHARLES   L.   DANA..  217 

Occupational  Eye  Diseases ELLICE    M.    ALGER..  223 

Industrial    Poisoning DAVID    L.    EDSALL  . . .  231 

Cooperation       in        Promoting       Industrial 

Hygiene  HENRY  R.  SEAGER.  . .  235 

GENERAL  DISCUSSION 242 

II.     INVESTIGATION  OF  INDUSTRIAL  DISEASES. 

Intensive       Investigations       in       Industrial 

Hygiene  F.    L.    HOFFMAN 255 

Compulsory  Reporting  by  Physicians   LEONARD   W.   HATCH  264 

Lead  Poisoning  in  New  York  City EDWARD    E.    PRATT.  .  273 

GENERAL  DISCUSSION 281 

III.  HEALTH  PROBLEMS  IN  MODERN  INDUSTRY. 

The  Function  of  Hospitals  and  Clinics  in  the 

Prevention  of  Industrial  Disease RICHARD  CABOT 293 

Temperature  and  Humidity  in  Factories C.-E.  A.  WINSLOW..  297 

Air  Impurities — Dusts,  Fumes,  and  Gases . . .  CHARLES  BASKERVILLE  305 
Effects  of  Confined  Air  Upon  the  Health  of 

Workers     GEORGE  M.  PRICE 312 

GENERAL  DISCUSSION 317 

IV.  STATE  PROMOTION  OF  INDUSTRIAL  HYGIENE. 

Education  for  the  Prevention  of  Industrial 

Diseases  M.  G.  OVERLOCK 329 

Notification  of  Occupational  Diseases CRESSY  L.  WILBUR..  339 

Medical  Inspection  of  Factories  in  Illinois . .  HAROLD  K.  GIBSON  . .  346 

Compressed- Air  Illness  in  Caisson  Work L.  M.  RYAN 350 

Legal  Protection  for  Workers  in  Unhealthful 

Trades    JOHN  B.  ANDREWS.  .  356 

GENERAL  DISCUSSION 363 

V.     BIBLIOGRAPHY  ON  INDUSTRIAL  HYGIENE. 

American  Titles    369 

Titles   Other  Than  American    .  397 


The  American  Labor  Legislation  Review  is  published  quarterly  by  the  American  Asso- 
ciation for  Labor  Legislation,  131  East  23d  St.,  New  York,  N.  Y.  The  price  is  one  dollar 
per  single  copy,  or  three  dollars  per  year  in  advance.  An  annual  subscription  includes 
individual  membership  in  the  Association. 


Princeton  University  Press 
Princeton,  N.  J. 


260181 


DRY  SANDPAPERING 

DRY  SANDING  OF  PAINT  is  A  FREQUENT  CAUSE  OF  LEAD   POISONING. 
OPERATION  FILLS  THE  AIR  WITH  TINY  PARTICLES  OF  LEAD  DUST 


THE 


WET   SANDING  WITH   PUMICE  STONE 
DUST  is  AVOIDED  WHEN  SANDING  is  DONE  WITH  WET  PUMICE  STONE 


INTRODUCTION 


When  the  American  Association  for  Labor  Legislation  called 
the  First  National  Conference  on  Industrial  Diseases,  in  Chicago 
in  June,  1910,  it  was  possible  only  to  mention  the  appointment  of 
the  first  state  commission  on  occupational  diseases  and  to  note  the 
completion  of  an  investigation  of  one  industrial  poison.  That 
practically  marked  the  extent  of  serious  public  interest  in  dis- 
eases of  occupation,  and  the  first  conference  attracted  attention 
to  this  as  to  a  new  problem.  Since  then  there  has  been  a  re- 
markable development  of  interest  in  the  subject. 

The  Memorial  on  Occupational  Diseases,  prepared  by  a  com- 
mittee of  the  first  conference,  laid  the  foundation  for  and  strongly 
urged  national  investigation  of  industrial  hygiene.  One  after 
another  eight  states  have  since  then  passed  the  Association  for 
Labor  Legislation's  standard  bill  requiring  physicians  to  report 
all  cases  of  certain  diseases  of  occupation.  The  work  of  the  one 
state  commission,  in  Illinois,  led  to  the  enactment  of  a  special 
occupational  disease  law  requiring  monthly  medical  examinations 
of  workmen  in  a  few  of  the  most  hazardous  employments.  In 
April,  1912,  the  United  States  Congress  agreed,  by  passing  the 
Association's  bill  placing  a  prohibitive  tax  on  poisonous  phos- 
phorus matches,  to  abolish  "phossy  jaw",  the  occupational  disease 
due  to  the  one  industrial  poison  which  had  then  been  thoroughly 
studied.  In  the  meantime,  the  List  of  Industrial  Poisons,  pre- 
pared by  the  International  Association  for  Labor  Legislation  and 
translated  by  the  United  States  Bureau  of  Labor,  gave  definite 
direction  to  further  investigations.  Reports  on  industrial  pois- 
oning from  lead  and  mercury  have  already  been  published,  and 
medical  inspection  of  factories  has  increased  in  importance. 

The  Second  National  Conference  on  Industrial  Diseases,  in  At- 
lantic City,  June,  1912,  was  attended  by  practicing  physicians, 
state  and  federal  public  health  officials,  medical  inspectors  of 
factories,  physiologists,  investigators  and  statisticians,  manu- 
facturers, efficiency  engineers,  insurance  experts,  labor  leaders, 
economists,  and  social  workers.  Through  an  industrial  hygiene 
exhibit,  the  first  extensive  display  of  the  kind  in  America,  in- 


dustrial  processes  dangerous  to  health  and  the  effects  of  these 
peculiar  work  hazards,  including  such  diseases  as  "phossy  jaw", 
lead  poisoning,  arsenic  poisoning,  compressed-air  illness  and  nu- 
merous occupational  eye  and  skin  diseases,  were  graphically 
placed  before  the  audience.  These  photographs,  charts,  and 
drawings  were  realistically  and  effectively  supplemented  by 
stereopticon  illustrations,  made  by  the  new  process  in  color 
photography.  Finally,  through  the  medium  of  a  joint  session 
with  the  American  Medical  Association,  that  organization,  for  the 
first  time  in  the  sixty-six  years  of  its  existence,  gave  a  place  to  the 
industrial  disease  problem  on  its  annual  program. 

There  is  now  scarcely  a  public  meeting  of  importance  for 
the  discussion  of  any  phase  of  the  labor  problem  that  does  not 
include  at  least  some  mention  of  occupational  diseases.  Three 
federal  bureaus  are  now  making  investigations  in  their  own  re- 
spective fields,  and  several  state  commissions,  bureaus  of  factory 
inspection,  and  boards  of  health  are  at  work  upon  the  problem. 
The  American  Association  for  Labor  Legislation  has  now  pub- 
lished and  distributed  no  less  than  forty  papers  and  reports  on 
occupational  diseases  and  industrial  hygiene.  The  publication  at 
this  time,  through  the  cooperation  of  the  Association  for  Labor 
Legislation,  the  Library  of  Congress,  and  the  United  States 
Bureau  of  Labor,  of  a  special  Bibliography  on  Industrial  Hy- 
giene, will  make  further  researches  less  difficult. 

The  proceedings  of  the  Second  National  Conference  on  Indus- 
trial Diseases,  here  made  available  in  permanent  form,  should  give 
a  new  impetus  to  the  nation-wide  campaign  for  the  promotion  of 
industrial  hygiene.  The  members  of  the  Association  for  Labor 
Legislation  may  well  feel  that  by  intelligent  cooperation  along 
definite  lines  they  have  made  a  promising  beginning  in  the  im- 
portant work  of  conserving  the  health  and  lives  of  industrial 
workers. 

JOHN  B.  ANDREWS,  Secretary, 
American  Association  for  Labor  Legislation. 


I 

SYMPOSIUM  ON  INDUSTRIAL  DISEASES 
JOINT  SESSION  WITH  THE  AMERICAN  MEDICAL  ASSOCIATION 


Presiding  Officer:    RUPERT  BLUE 

Surgeon  General,  United  States  Public  Health 

and  Marine  Hospital  Service 

WASHINGTON,  D.  C. 


CLASSIFICATION  OF  OCCUPATIONAL  DISEASES 


W.  OILMAN  THOMPSON 
Cornell  University  Medical  College. 


In  order  to  establish  a  satisfactory  classification  of  the  occupa- 
tional diseases  and  the  industrial  hazards  which  give  origin  to  them, 
it  is  necessary  to  agree  upon  ^a  standard  nomenclature  which  may 
prove  not  only  of  scientific  value,  but  constitute  a  working  basis  for 
such  remedial  legislation  as  may  prove  desirable.  The  authority 
for  such  nomenclature  and  classification  is  properly  vested  in  the 
United  States  Bureau  of  the  Census  which,  being  a  national  insti- 
tution, is  better  fitted  for  this  work  than  the  local  municipal  or 
state  boards  of  health  or  labor  bureaus.  Agreement  as  to  uniform- 
ity among  the  latter  would  obviously  involve  much  time  and  dis- 
cussion, with  probably  less  satisfactory  ultimate  results. 

The  Bureau  of  the  Census  already  furnishes  a  generally  accepted 
classification  of  the  causes  of  death  from  ordinary  diseases  and 
includes  a  number  of  causes  of  death  from  occupational  diseases, 
about  one  hundred  of  which  are  enumerated  in  the  Mortality 
Statistics  Bulletin  No.  108,  1909,  p.  33.  But  this  list  is  obviously 
merely  tentative,  else  why  should  the  making  of  neckties  be  included 
as  hazardous  and  the  caisson  disease  be  omitted,  of  which,  in  the 
admirable  report  of  Dr.  F.  L.  Keays,  twenty  fatal  cases  are  re- 
corded as  occurring  within  a  few  years  in  New  York  City  alone? 
Fortunately,  the  Bureau  of  the  Census  is  at  present  cooperating 
with  the  Committee  of  the  American  Medical  Association  on  the 
Nomenclature  and  Classification  of  Diseases,  and  it  is  to  be  hoped 
that  they  will  find  time  to  include  in  this  work  the  formulaton  of  a 
complete  classification  of  the  disease  hazards  and  deleterious  sub- 
stances which  are  causatively  related  to  the  industrial  diseases, — 
irrespective  of  mortality  statistics.  As  far  as  these  diseases  are 
themselves  concerned,  they  are  fairly  well  named  and  classified 
already,  but  not  in  connection  with  their  causation.  For  example, 
arteriosclerosis  or  chronic  nephritis  due  to  chronic  lead  poisoning 
do  not  differ  materially  from  the  same  diseases  originating  from 


1 86  American  Labor  Legislation  Review 

syphilis,  chronic  alcoholism,  gout  and  other  etiological  factors.  Nor 
does  a  bronchitis  due  to  inhaling  dust  in  a  cotton  mill  differ  essen- 
tially from  that  acquired  in  other  ways.  In  fact,  apart  from  the 
lesions  of  the  caisson  disease,  and  a  few  of  the  bone  lesions,  occupa- 
tional tics  and  palsies,  there  is  little  that  is  new  in  those  of  the 
diseases  of  hazardous  industries,  and  little  which  cannot  be  included 
in  existing  medical  nomenclature  as  applied  to  disease  in  general. 

A.  HARMFUL  SUBSTANCES 

The  injurious  substances  employed,  however,  present  a  somewhat 
more  complex  problem,  mainly  because  their  number  is  rapidly 
increasing,  and  any  system  of  classification  should  be  an  elastic  one, 
permitting  of  extension  and  providing  for  a  large  miscellaneous 
group.  For  example,  the  great  majority  of  injurious  substances 
may  be  comprised  under  the  six  general  headings:  (i)  Metal 
poisons,  including  the  metallic  salts;  (2)  toxic  gases,  vapors  and 
fumes;  (3)  toxic  fluids  (such  as  acids  and  alkalies,  petroleum 
products,  etc.);  (4)  toxic  or  irritant  dusts,  subdivided  into: 

(a)  insoluble  inorganic  dusts  (irritating  the  respiratory  passages )y 

(b)  soluble  inorganic  dusts  (liable  to  be  swallowed  and  absorbed), 

(c)  organic  dusts  and  fibers;  (5)  organic  germs  (such  as  those  of 
glanders  and  anthrax)  ;  and  (6)  miscellaneous  irritants. 

Under  these  major  headings  may  be  grouped  practically  all  of 
the  irritant  substances,  yet  certain  difficulties  arise  even  in  this 
elementary  arrangement.  For  example,  lead,  which  of  course  would 
be  classed  as  a  simple  metal  poison,  is  also,  when  heated,  to  be 
,  ranked  among  the  toxic  fumes,  and  again,  in  the  form  of  filings,  as 
a  soluble  inorganic  dust.  As  this  applies  to  many  of  the  other 
metals,  to  repeat  them  all  under  each  subheading  would  be  cumber- 
some. Phosphorus,  for  instance,  is  a  metal,  yet  it  is  as  a  toxic 
fume  that  it  works  such  havoc,  and  it  had  better  be  classed  with  the 
latter. 

Furthermore,  the  names  of  many  substances  may  convey  no  inti- 
mation of  their  special  hazards.  For  example,  whether  ferrosili- 
con  be  classed  among  the  metals  as  containing  iron  and  traces  of 
arsenic,  or  as  a  liquid,  since  by  itself  it  is  non-toxic,  neither  of  these 
groups  would  suggest  its  real  hazard,  which  consists  in  the  acci- 
dental access  of  water,  producing  the  combination  arseniuretted 
hydrogen  gas  that  has  cost  many  lives,  especially  on  ships  in  which 
the  ferrosilicon  was  being  transported. 


Classification  of  Occupational  Diseases  187 

For  such  reasons,  it  would  seem  best  to  class  each  substance 
primarily  in  the  major  group  which  its  most  common  form  and  use 
suggest,  and,  when  its  common  name  conveys  no  idea  of  the  hazard, 
to  indicate  the  latter  in  parenthesis.  Thus  ferrosilicon  would  be 
grouped  under  toxic  liquids,  and  a  parenthesis  should  follow, 
reading  "(arseniuretted  hydrogen  gas,  on  hydration)". 

B.  HARMFUL  CONDITIONS  OF  PHYSICAL  ENVIRONMENT 
The  above  general  classification  refers  only  to  the  material  haz- 
ards, so  to  speak,  and  does  not  provide  for  the  injuries  arising  from 
environmental  or  physical  conditions,  such  as  the  air  compression 
affecting  tunnel  and  caisson  workers  and  divers,  the  rarefied  air  af- 
fecting aviators,  or  the  tunnel  injuries  to  the  ears.  Nor  does  it  pro- 
vide for  the  injuries  arising  from  excessive  temperature  changes  as 
affecting  smelter  employees,  stokers,  workers  in  cold-storage,  etc.  A 
group,  therefore,  of  hazardous  occupations  due  to  physical  environ- 
ment should  be  established,  including  hazards  from  excessive  varia- 
tions in  (a)  air  pressure,  (b)  humidity,  (c)  air  temperature,  and 
(d)  light  (including  electric  light,  the  X-ray,  etc.). 

C.  INJURIES  (MEDICAL)  TO  NERVES,  MUSCLES,  AND  BONES 
Another  general  group  of  occupational  hazards  is  necessary  to 
comprise  disease  injuries  to  nerves,  muscles,  and  bones,  arising  from 
such  conditions  as  occupational  strain,  fatigue,  repeated  blows  and 
vibrations,  excessive  pressure,  repeated  muscular  contractions,  and 
faulty  positions  assumed  in  working  at  benches,  handling  many 
forms  of  tools,  etc.  The  large  group  of  "occupational  neuroses", 
with  cramps,  palsy,  tremors,  tics,  neuralgia,  neuritis,  and  vaso-motor 
disorders,  should  be  included  as  subdivisions  of  this  group.  To  this 
also  may  be  added  a  subclass  comprising  insomnia,  headache,  general 
nervousness  as  from  "speeding  up",  etc. 

D.  INJURIES  OF  SPECIAL  ORGANS 

Other  primary  groups  of  occupational  diseases  should  include 
injuries  of  special  organs:  namely,  (i)  injuries  to  the  skin;  (2) 
injuries  to  the  eyes;  (3)  injuries  to  the  ears;  and  (4)  injuries  to 
the  nose  and  throat. 

Under  the  foregoing  general  classification,  with  appropriate  sub- 
divisions, may  be  included  all  the  specific  causes  of  occupational 
diseases,  namely,  the  (a)  material,  (b)  chemical,  (c)  physical, 
and  (d)  physiological  causes. 


1 88  American  Labor  Legislation  Review 

CLASSIFICATION  OF  HAZARDOUS  OCCUPATIONS 

There  remains  to  be  dealt  with  the  classification  of  hazardous- 
occupations,  which  is,  from  every  point  of  view,  a  far  more  difficult 
task.  While  it  is  true  that  some  few  definite  occupations,  like  that 
of  the  caisson  and  tunnel  workers,  each  produce  a  single  definite 
disease  from  a  single  definite  cause,  very  many  industries  are  so 
complex  as  to  give  rise  to  many  different  hazards  and  as  many  dif- 
ferent diseases.  A  classification  which  fails  to  make  this  clear  fails 
of  its  primary  object,  and  is  not  alone  useless  but  may  prove  unfair 
as  a  basis  for  remedial  legislation  or  scientific  deductions.  But  to 
specify  all  the  subdivisions  of  labor  in  a  complex  industry  is  to 
accumulate  a  catalogue  of  many  thousands  of  technical  terms  and 
easily  to  become  lost  in  a  maze  of  phraseology.  It  is  precisely  in 
this  understanding  of  technical  work  that  physicians  as  a  body 
need  education,  for  upon  them  must  devolve  the  collection  of 
disease  data,  if  such  data  are  to  be  confirmed  by  accurate  diagnoses. 
It  is  not  customary,  as  yet,  to  give  systematic  instruction  in  medical 
colleges  upon  occupational  diseases.  Most  of  the  standard  text- 
books on  medicine  refer  to  scarcely  a  half  dozen  of  the  industrial 
poisons,  such  as  lead  or  arsenic,  and  the  literature  of  this  topic 
adapted  for  use  in  this  country  is  scattered  mainly  in  isolated 
monographs  and  a  few  brief  journal  articles. 

One  or  two  illustrations  will  serve  to  emphasize  the  difficulties  of 
properly  classifying  the  occupations  involving  disease  hazards.  If 
a  workman  be  classed  merely  as  a  "potter"  he  may  be  employed  in 
glazing  or  polishing  and  acquire  lead  poisoning ;  or,  as  in  the  Limoge 
works  in  France,  he  may  be  a  grinder  subject  to  inhalation  of  silica 
dust,  and  may  acquire  fibroid  phthisis  and  subsequently  tuberculosis ; 
or  as  a  molder  he  may  be  exposed  to  constant  humidity  and  may 
suffer  from  rheumatism  or  chronic  bronchitis.  Obviously,  to  class 
him  solely  as  a  potter  supplies  information  so  incomplete  as  to  be 
almost  useless.  Other  terms  are  still  more  ambiguous.  For  example, 
a  "hatter"  may  be  engaged  in  the  non-hazardous  occupation  of  selling 
hats,  may  be  a  maker  of  straw  hats,  associated  either  with  no  hazard 
or  with  the  minor  one  of  using  some  bleaching  substance  or  inhaling 
straw  dust,  or  may  be  a  man  who  is  employed  in  making  felt  hats. 
This  latter  industry  is  so  subdivided  that  the  man  may  rank  as  a 
blocker,  blower,  pouncer,  flanger,  curler,  shearer,  stiffener,  singer, 
trimmer,  coner,  dyer,  dryer,  feeder,  hardener,  mixer,  welter,  or 


2. 

ARSENIC  POISONING 

1.  PUTTING  PARIS  GREEN  INTO  A  BOLTER.     AN  OLD  AND  DANGEROUS  METHOD 

2.  A  COMPARATIVELY  DUSTLESS  BOLTER.    RESPIRATORS  WORN  AS  AN  ADDITIONAL 

PROTECTION 


Classification  of  Occupational  Diseases  189 

finisher.  In  about  half  of  these  labors  he  would  be  subject  to  no 
hazard  whatever,  as  for  instance  if  he  be  a  curler  or  finisher;  but 
if  he  be  a  fur-cutter,  "maker"  or  sizer  he  is  very  susceptible  to  bron- 
chial irritation  and  liable  to  add  to  the  tuberculosis  mortality.  If, 
on  the  other  hand,  he  be  a  pouncer  he  is  almost  certain  to  acquire 
chronic  mercurial  poisoning  and  sooner  or  later  to  become  wholly 
incapacitated  for  work,  and  he  may  possibly  die  as  a  result  of  his 
labor. 

In  confirmation  of  the  lack  of  information  among  manufacturers, 
or  of  their  much  worse  willful  neglect  of  the  humanitarian  interest 
which  they  ought  to  exercise,  is  the  common  observation  of  all  who 
have  made  special  investigations  in  lead  poisoning  that  the  manu- 
facturers almost  universally  profess  ignorance  as  to  its  existence,  at 
least  in  their  own  establishments.  Yet  in  New  York  State,  Dr.  John 
B.  Andrews  has  compiled  data  of  sixty  cases  of  death  from  this 
cause  occurring  within  the  two  years  1909  and  1910,  and  I  have 
personally  collected  data  from  only  two  hospitals  and  one  dispensary 
in  New  York  City  of  over  three  hundred  cases  of  lead  poisoning  so 
serious  as  to  demand  hospital  treatment,  and  sometimes  to  produce 
permanent  disability. 

Before  a  standard  classification  of  occupational  diseases  is  adopted, 
attention  should  be  given  to  the  educational  needs  of  the  situation. 
A  classification  which  is  too  elaborate  may  fail  of  its  chief  purpose, 
which  is  to  interest  physicians  in  this  important  humanitarian, 
scientific,  and  legislative  work,  i.  e.  the  control  and  mitigation  of 
the  occupational  disease  hazards.  It  is  desirable,  therefore,  to 
furnish  physicians  and  employers  with  a  simple  general  classifica- 
tion, after  the  form  outlined  in  this  article,  and  to  supplement  it 
with  a  more  elaborate  classification  to  be  supplied  to  special  investi- 
gators in  hospitals  and  dispensaries,  or  to  those  who  have  access  to 
the  study  of  large  groups  of  cases.  It  is  clearly  undesirable  that 
hasty  or  unfair  legislation,  based  on  insufficient  data,  should  be 
enacted,  and  it  is  therefore  of  the  greatest  importance  that  physi- 
cians everywhere  enter  into  hearty  cooperation  with  the  state 
authorities  in  the  collection  of  accurate  statistics  which  shall  be  of 
true  scientific  value. 

A  beginning  has  been  made  in  eight  states  by  the  enactment  of 
laws  requiring  physicians  to  report  six  of  the  occupational  diseases, 
namely,  those  due  to  four  metals,  lead,  arsenic,  mercury,  and  phos- 


190  American  Labor  Legislation  Review 

phorus,  to  one  germ,  the  anthrax  bacillus,  and  the  caisson  disease. 
This  list  will  doubtless  be  extended  considerably  in  the  near  future, 
and  among  the  first  additions  should  be  wood-alchohol  poisoning. 
This  substance  is  used  to  dissolve  the  shellac  for  varnish  which  is 
often  applied  in  confined  spaces,  such  as  the  linings  of  brewery  vats, 
where  the  alcohol  fumes  accumulate.  There  were  two  deaths  and 
a  case  of  permanent  blindness  from  this  cause  in  Buffalo  recently, 
and  three  other  deaths,  the  last  one  of  which  was  diagnosed  by  the 
physician  who  was  summoned  as  a  case  of  "epilepsy",  occurred  in 
a  brewer's  vat  in  New  York. 

As  an  aid  to  meet  the  educational  requirements  of  classification 
in  New  York  State,  I  have  furnished  the  state  labor  bureau  with 
a  brief  general  classification  of  occupational  hazards  and  harmful 
substances,  which  is  printed  on  the  backs  of  the  notification  blanks 
required  by  law  to  be  sent  to  each  physician.  I  also  furnished  a 
more  elaborate  classification  which  is  printed  in  small  booklet  form 
and  is  designed  for  distribution  to  hospitals  and  dispensaries,  social 
service  workers,  and  all  physicians  who  will  take  interest  enough  to 
gather  special  data.  As  far  as  possible  this  classification  is  arranged 
in  four  parallel  columns,  headed  respectively  "Industry",  "Harmful 
Substance",  "Mode  of  Entrance",  "Symptoms  and  Diagnosis." 

For  my  own  use  and  that  of  my  assistants  in  hospital  and  dispen- 
sary work,  I  have  designed  history  cards  with  headings  calling  for 
classified  data,  one  set  for  the  metal  poisons,  another  for  the  dust 
and  fiber  irritants,  etc.  From  such  uniformly  classified  cards  it  is 
easy  to  compile  scientific  data  for  any  particular  group  of  diseases. 

CONCLUSION 

In  conclusion,  I  would  recommend  (i)  that  the  Bureau  of  the 
Census  establish  a  uniform  nomenclature  and  classification  as  com- 
plete as  possible,  to  be  used  as  a  national  standard;  and  (2)  that 
the  state  labor  bureaus  or  health  boards  issue  a  standard  notification 
blank  like  the  one  in  use  in  New  York  State,  which  is  modeled  after 
the  national  death  certificate  blank  of  the  Bureau  of  the  Census.  On 
the  back  of  this  blank  should  be  printed  a  brief  working  classifica- 
tion of  the  commoner  occupational  hazards  and  harmful  substances, 
emphasizing  in  black  letters  the  most  important  ones.  And  I  would 
also  recommend  (3)  that  there  should  similarly  be  issued  to  all  who 
will  make  use  of  it,  a  more  comprehensive  classification  in  booklet 


Classification  of  Occupational  Diseases  191 

form,  detailing  the  symptoms  in  parallel  columns  with  the  injurious 
substances  liable  to  produce  them. 

GENERAL  CLASSIFICATION  OF  OCCUPATIONAL  DISEASES 
AND  HARMFUL  SUBSTANCES 

A.  Harmful  Substances: 

1.  Metallic  poisons. 

2.  Toxic  gases,  vapors,  and  fumes. 

3.  Toxic  fluids  (acids,  alkalies,  dyes,  etc.). 

4.  Irritant  dusts  and  fibers. 

(a)  Insoluble  inorganic  dusts. 

(b)  Soluble  inorganic  dusts. 

(c)  Organic  dusts  and  fibers. 

5.  Organic  germs  (anthrax,  glanders,  etc.). 

6.  Miscellaneous  irritants. 

B.  Harmful  Conditions  of  Environment: 

1.  Air  compression  and  rarefaction. 

2.  Excessive  humidity. 

3.  Extreme  heat  and  cold. 

4.  Excessive  light  (electric,  X-ray,  etc.). 

C.  Occupational  Injuries: 

(Medical) 

1.  Injuries  to  nerves,  muscles  and  bones. 

(Strain,    fatigue,    cramp,    faulty   positions,    "occupational 
neuroses",  blows,  vibrations,  pressure,  etc.) 

2.  Injuries  to  the  eyes. 

3.  Injuries  to  the  ears. 

4.  Injuries  to  the  nose  and  throat. 

5.  Injuries  to  the  skin. 

OCCUPATIONAL  DISEASES  OF  THE 

1.  Blood. 

2.  Circulatory  system. 

3.  Respiratory  system. 

4.  Nervous  system. 

5.  Digestive  system. 

6.  Muscular  system. 

7.  Cutaneous  system. 

8.  Urinary  system. 

9.  Special  sense  organs. 


COMPRESSED-AIR   ILLNESS 


FREDERICK  L.  KEAYS 
Cornell  University  Medical  College. 


This  paper  is  based  largely  upon  a  report,  made  by  the  writer  in 
I9°91>  of  3692  cases  of  compressed-air  illness  which  resulted  at  the 
Pennsylvania  East  River  Tunnels  during  the  time  that  he  was  medi- 
cal director.  It  will  present  a  brief  general  description  of  the  subject 
of  compressed-air  illness,  special  attention  being  paid  to  its  cause 
and  to  its  prevention. 

Triger,2  a  French  engineer,  who  designed  the  first  practical  caisson 
in  1839,  mentioned  the  occurrence  of  pains  in  the  extremities  of 
workmen  employed.  In  1868,  Le  Roy  de  Mericourt3  published 
the  first  medical  report  of  illness  among  sponge-divers.  Since 
Triger's  report  many  contributions  have  been  made  to  the  subject 
of  compressed-air  illness.  A  full  review  of  the  literature  of  the 
subject  may  be  found  in  Caisson  Sickness  by  Leonard  Hill,  a  book 
published  this  year. 

ETIOLOGY — CAUSES 

Various  theories  have  been  advanced  to  explain  the  symptoms 
occurring  among  compressed-air  workers.  The  earliest  theory  to 
receive  general  recognition  was  that  advocated  by  Pol  and  Wattelle4 
in  1854,  the  so-called  mechanical-congestion  theory.  In  1878 
Paul  Bert5  proposed  the  theory,  supporting  it  by  logical  reason- 
ing and  by  experiments,  which  is  now  universally  accepted.  It  is 

1  Keays,  "Compressed-Air  Illness,  With  a  Report  of  3692  Cases,"  Researches 
from  the  Department  of  Medicine,  Publications  of  Cornell  University  Medi- 
cal College,  Vol.  II,  pp.  1-55. 

2  Triger,  "Compte  rendus,"  Acad.  des  Sciences,  1841,  tome  XIII,  p.  884 
*De  Mericourt,  Bull  de  I'Academie  de  Med.,  1868,  XXXIII.    Ann.  d'Hygiene 

Publ.  et  de  Med.  Legate,  1869,  second  series,  XXXI. 

4  Pol  and  Wattelle,  "Memoire  sur  les  Effets  de  la  Compression  de  1'Air." 
Annal.  d'Hyg.  Publique  et  de  Med.  Legate.  Paris,  1854. 

"Bert,  La  Pression  Barometrique.     Paris,  1878. 


CROSS  SECTION  OF  CAISSON  IN  FULL  OPERATION 

WORKERS  ("SAND  HOGS")  Ax  BOTTOM  OF  CAISSON  WORK  UNDER  ATMOSPHERIC 

PRESSURE   SUFFICIENT  TO   PREVENT  WATER  FROM   FLOWING 

IN  As  SAND  is  SHOVELLED  UP 

Too   RAPID  DECOMPRESSION,  AS   IN   GOING   SUDDENLY  CUT   INTO  THE   NORMAL 
ATMOSPHERE,  CAUSES  COMPRESSED-AIR  ILLNESS 


Compressed-Air  Illness  193 

a  surprising  fact  that  Bert's  explanation  was  practically  disregarded 
for  several  years,  while  the  mechanical-congestion  theory  continued 
to  be  accepted,  especially  by  the  early  American  writers. 

Briefly  stated,  Bert's  theory  is  as  follows :  The  blood  of  a  man  or 
of  an  animal,  when  in  compressed  air,  takes  into  solution  an  in- 
creased quantity  of  oxygen  and  nitrogen  from  the  air,  the  quantity 
of  the  gases  absorbed  being  in  direct  proportion  to  the  increase  of 
pressure.  The  gases  taken  up  by  the  blood  are  gradually  distributed 
to  the  fluids  of  the  various  tissues.  With  rapid  decompression  the 
nitrogen  gas  bubbles  off  in  the  blood.  These  bubbles  act  as  emboli, 
block  up  the  capillaries  in  one  or  another  part  of  the  body  and,  by 
cutting  off  the  blood  supply  or  by  direct  mechanical  violence,  cause 
the  symptoms  of  compressed-air  illness.  Symptoms  of  illness  may 
be  prevented  by  making  decompression  slow  enough  to  allow  the 
absorbed  nitrogen  to  escape  from  the  lungs.  Further  experimenta- 
tion by  Von  Schrotter,6  Hill  and  his  associates,7  and  others,  have 
confirmed  his  theory.  Post-mortem  findings,  moreover,  in  many  fatal 
cases  of  compressed-air  illness,  both  in  men  and  in  animals,  give 
conclusive  proof  that  this  theory  is  correct. 

LFrom  this  theory,  as  well  as  from  practical  experience,  the  chief 
etiological  factors  have  been  deduced  as  follows :  ( I )  In  general, 
the  higher  the  pressure,  the  greater  the  chances  of  illness;  (2) 
the  longer  the  time  of  pressure,  the  greater  the  chances  of  illness ; 
and  (3)  the  more  rapid  the  decompression,  the  greater  the  chances 
of  illness. 

Let  us  now  consider  these  three  factors  in  brief  detail. 

I.  The  degree  of  pressure. — Practical  experience  has  shown  that 
cases  of  compressed-air  illness  seldom  happen  at  pressures  up  to 
fifteen  pounds  per  square  inch  above  normal.8  Fatal  cases  seldom 
result  from  pressures  below  thirty  pounds.  The  lowest  pressure 
from  which  death  has  been  reported  is  twenty-one  pounds,  and  there 
seems  to  be  some  doubt  as  to  the  authenticity  of  this  report.  Among 

'Heller,  Mager  and  von  Schrotter,  Die  Luftdruckerkrankungen,  Vienna, 
1900. 

T  Hill  and  Macleod,  "Caisson  Disease  and  Diver's  Palsy,"  Journal  of  Hy- 
giene, 1903,  p.  401 ;  Hill  and  Greenwood,  Proceedings  Royal  Society,  B.  Vol. 
77,  P.  442,  1906;  Vol.  79,  p.  21  and  p.  284,  1907. 

"The  figures  in  regard  to  pressure  given  in  this  paper  all  refer  to  the 
number  of  pounds  per  square  inch  above  normal  atmospheric  pressure,  which 
is  a  little  less  than  15  pounds. 


194 


American  Labor  Legislation  Review 


twenty  fatal  cases  of  compressed-air  illness  resulting  at  the  Pennsyl- 
vania East  River  Tunnels,  only  two  were  caused  by  pressures  below 
thirty  pounds,  one  at  twenty-eight  pounds,  the  other  at  twenty-nine 
pounds.  The  following  table,  taken  at  random  from  the  records  of 
the  Pennsylvania  East  River  Tunnels,  illustrates  the  influence  of 
only  slight  additions  of  pressure  upon  the  percentage  of  cases  of 
illness,  when  pressures  in  the  neighborhood  of  thirty  pounds  were 
being  used. 

TUNNEL  A.    MANHATTAN  SITE. 


Month 

Number  of 
Man-shifts 

Length 
of  Shifts 

AveragePres- 
sure  Above 
Normal 

No.    Cases  ol 
Comp.-Air 

Illness* 

Per 

Cent 

Jan.  '07 

3751 

8  hours 

28.5  Ibs. 

7 

.18+ 

Feb.  '07 

4141 

6  hours 
(2-3  hr.  periods) 

31  Ibs. 

25 

.60-f 

Mar.  '07 

4902 

<( 

31.5  Ibs. 

33 

.67+ 

Apr.  '07 

4018 

<( 

32  Ibs. 

39 

.97+ 

It  may  be  stated  that,  with  other  conditions  the  same,  the  number 
of  cases  of  illness  will  depend  directly  upon  the  degree  of  pressure. 

2.  The  time  under  pressure. — When  pressures  of  one  atmos- 
phere or  more  are  being  used,  the  time  spent  under  pressure  is  an 
important  etiological  factor.  It  is  obvious  that  if  less  time  is  spent 
in  compressed  air  than  is  necessary  for  complete  saturation  of  the 
body  fluids,  the  chances  of  symptoms  developing  upon  decompres- 
sion will  be  less  than  if  that  time  is  equalled  or  exceeded.  The 
exact  time  in  which  complete  body  saturation  takes  place  has  never 
been  determined.  No  doubt  it  varies  in  different  individuals.  It  is 
certainly  hastened  by  work  and  exercise.  Some  parts  of  the  body 
saturate  quickly  and  others  slowly.  Fat  especially  saturates  slowly, 
both  on  account  of  its  poor  blood  supply  and  because  it  has  the 
property  of  absorbing  about  six  times  as  much  nitrogen  as  the  other 
body  fluids.  Haldane  and  Boycott9  estimated  that  half  saturation 
of  the  body  occurs  in  about  twenty-five  minutes,  and  almost  full 
saturation  in  about  ninety  minutes. 

•  Boycott,  Damant  and  Haldane,  "The  Prevention  of  Compressed-Air  Ill- 
ness," Journal  of  Hygiene,  Vol.  VIII,  No.  3,  June,  1908. 


Compressed- Air  Illness 


195 


In  the  Pennsylvania  East  River  Tunnels,  when  pressures  of 
30  Ibs.  and  more  were  being  used,  all  new  men,  before  being  allowed 
to  work,  were  given  a  preliminary  test  at  the  prevailing  tunnel  pres- 
sure which  lasted  90  minutes,  decompression  being  at  the  rate  of 
two  pounds  per  minute.  In  2719  preliminary  tests  only  three  cases 
of  compressed-air  illness  were  encountered.  Two  of  these  were 
mild  cases  of  pain,  and  the  third  was  a  case  of  paralysis  of  the  lower 
extremities.  After  the  preliminary  test,  those  who  took  it  satis- 
factorily were  allowed  to  work  90  minutes  when  six-hour  shifts 
were  in  progress.  In  2000  men  who  worked  for  90  minutes  in 
pressures  averaging  32  Ibs.,  seven  cases  of  compressed-air  ill- 
ness resulted,  all  being  mild  cases.  The  small  number  of  cases  in 
the  former  group  would  indicate  that  complete  saturation  had  not 
taken  place  in  90  minutes.  The  influence  of  work  in  hastening 
absorption  would  account  for  the  increased  number  of  cases  in  the 
latter  group. 

The  following  table,  made  up  from  the  records  of  the  Pennsyl- 
vania East  River  Tunnels,  throws  some  practical  light  upon  the 
question  of  the  time  of  nearly  complete  body  saturation  and  of  the 
effect  of  work,  and  also  indicates  the  effect  of  fatigue,  as  shown  by 
a  comparison  of  the  number  of  cases  following  the  first  and  the 
second  three-hour  periods  of  six-hour  daily  shifts: 


Average 
Pressure 
(estimated) 

Time  under 
Pressure 

Number  of 
Men 

Ca 
Cor 
11 

No. 

ses  of 
np.-Air 
Iness 

Per  cent. 

Kemarks 

31  Ibs. 

\y2  hours 

2719 
Preliminary 
test,    not 
working 

3 

0.18+ 

2  cases  ordinary  pain. 
1  case  paralysis  legs. 

32  Ibs. 

\yz  hours 

2000  (estim- 
ated) 
Working 

7 

0.35+ 

All  ordinary  cases 
(pain,  vertigo,  etc.) 

29  Ibs. 

2  hours 

6000  (estim- 
ated) 
Working 

13 

0.21+ 

1   case  pain   and   prostra- 
tion, not  severe. 
Rest,  ordinary  cases. 

33  Ibs. 

3  hours 
1st  half  6-hr, 
shift 

43,680  (est.) 
Working  B.& 
D.  Tunnels, 
Manhattan 

162 

0.35+ 

4  fatal. 
2  pain  and  prostration. 
3  partial  paralysis. 
Rest,  ordinary  cases. 

33  Ibs. 

3  hours 
2nd  half  6-hr, 
shift 

it 

317 

0.72+ 

2  fatal. 
1  pain  and  prostration. 
1  partial  paralysis. 
Rest,  ordinary  cases. 

io,6  American  Labor  Legislation  Review 

The  decreased  percentage  of  cases  of  illness  from  two  hours 
work,  as  compared  with  that  from  one  and  one-half  hours  work, 
is  accounted  for  by  the  lower  pressures  in  the  former  case.  At 
the  same  pressure,  other  factors  being  equal,  two  hours  work 
would  probably  be  followed  by  more  cases  than  one  and  one-half 
hours  work.  In  comparing  results  from  three-hour  shifts  with 
those  from  one  and  one-half  and  two-hour  shifts,  it  should  be  noted 
that  in  the  former  case  the  percentages  were  based  chiefly  upon 
old  workmen;  but  in  the  latter  the  percentages  were  based  entirely 
upon  new  men. 

3.  The  time  of  decompression. — All  authorities  agree  that  the 
rate  of  decompression  is  a  most  important  factor  in  determining 
the  number  of  cases  of  compressed-air  illness,  as  well  as  in  de- 
termining their  severity.  During  decompression  the  absorbed  gases 
are  liberated  from  the  body  fluids  and  blood  in  the  form  of  bubbles, 
and  are  excreted  through  the  lungs.  The  rapidity  with  which  these 
gases  are  set  free,  and  the  size  of  the  gas  bubbles,  depend  directly 
upon  the  rate  at  which  the  pressure  is  removed.  Consequently 
rapid  decompression  increases  the  chances  of  illness  and  slow  decom- 
pression diminishes  them.  It  is  not  known  how  long  it  takes  for 
complete  desaturation ;  like  saturation  it  probably  differs  in  indi- 
viduals. The  practical  problem  is  to  find,  if  possible,  a  safe  rate 
of  decompression.  From  practical  experience  it  has  been  learned 
that  with  pressures  up  to  15  or  20  Ibs.  rapid  decompression  seldom 
gives  rise  to  any  symptoms,  and  probably  never,  even  after  long 
exposures  of  six  to  eight  hours,  to  those  due  to  large  quantities  of 
free  gas  in  the  circulatory  system.  An  explanation  of  this,  which 
appears  logical,  is  that  at  these  pressures  not  enough  gases  can  be 
absorbed  to  embarrass  the  circulation  even  when  suddenly  liberated. 
That  rapid  decompression  from  pressures  of  four  or  more  atmos- 
pheres is  more  dangerous  than  slow  decompression  has  been  re- 
peatedly demonstrated  in  animal  experimentation. 

Bert  concluded,  from  experiments  with  animals,  that  all  trouble 
could  be  avoided  by  allowing  thirty  minutes  for  decompression  from 
pressures  between  two  and  three  atmospheres  and  sixty  minutes  for 
decompression  from  pressures  between  three  and  four  atmospheres. 
Von  Schrotter  considers  an  allowance  of  twenty  minutes  per  atmos- 
phere safe;  and  Hill  and  his  associates  found  twenty  minutes  per 
atmosphere  safe  for  a  large  number  of  animals  exposed  to  satur- 


Compressed-Air  Illness 


197 


ation.  Haldane,10  on  the  other  hand,  advocates  the  interrupted  or 
stage  method  of  decompression.  Starting  from  the  fact  that  rapid 
decompression  from  19  Ibs.  to  normal  atmospheric  pressure  is  com- 
paratively safe,  he  argued  that  it  would  be  correspondingly  safe  to 
decompress  rapidly  from  four  to  two  atmospheres,  or  from  six 
to  three  atmospheres,  and  he  found  this  true  in  a  series  of  experi- 
ments with  animals.  He  proposes  the  following  rate  of  decompres- 
sion for  caisson  and  tunnel  work: 


Working  Pressure 
in  Pounds  per 
Square  Inch 

Number  of  Minutes  for  each  Pound  of  Decompression 
after  the  First  Kapid  Stage. 

After  first  3  hours' 
exposure 

After  second  or 
third  3  hours'  ex- 
posure following  an 
interval  for  a  meal. 

After  6  hours  or 
more  of  continuous 
exposure 

18-20 
21-24 
25-29 
30-34 
35-39 
40-45 

2 
3 
5 
6 

7 
7 

3 
5 

7 
7 
8 
8 

5 

7 
8 
9 
9 
9 

His  first  rapid  stage  of  decompression  reduces  the  pressure  in 
about  three  minutes  to  a  point  equal  to  one-half  the  actual  pressure. 
To  illustrate,  if  the  working  pressure  is  40  Ibs.,  the  actual  pressure 
equals  55  Ibs.  One-half  of  55  or  27.5  equals  the  actual  pressure,  or 
12.5  Ibs.  equals  the  gage  pressure.  Applying  this  table  to  decom- 
pression from  40  Ibs.,  one  would  reduce  the  pressure  in  about  three 
minutes  to  12.5  Ibs.  and  then  allow  87.5  minutes  for  decompression 
after  the  first  three  hours'  exposure. 

Haldane  presents  strong  theoretical  reasons  in  proof  of  the  advan- 
tages of  the  stage  method  of  decompression.  In  his  own  experiments 
with  goats,  however,  the  beneficial  results  of  stage  decompression,  as 
compared  with  the  uniform  decompression  of  equal  time,  are  less  ap- 
parent than  the  theory  would  lead  one  to  expect.  Hill  and  Green- 
wood11 tested  the  effects  of  uniform  and  stage  decompression  on  pigs 
without  showing  any  decided  advantage  for  the  latter  method.  Hill 
says :  "The  conclusion  to  be  drawn,  then,  from  experiments  on  ani- 
mals is  that  there  is  evidence  in  favor  of  stage  decompression  after 

10  Haldane,  "The  Hygiene  of  Work  in  Compressed  Air,"  Journal  of  the 
Society  of  Arts.    Vol.  XVI,  p.  214.    Jan.  1008. 
"Hill,  Caisson  Sickness,  Longmans,  N.  Y.,  1912. 


!<p8  American  Labor  Legislation  Review 

short  exposures,  but  no  decisive  evidence  of  its  superiority  after  long 
exposures.  The  theory  is  a  captivating  one,  but  experiment  has  not 
brought  that  conclusive  support  which  was  to  be  expected."  In  this 
statement  by  short  exposures  is  meant  periods  of  one  hundred  and 
twenty  minutes  or  less. 

Bornstein  compared  the  effects  of  stage  and  uniform  methods  at 
the  Elbe  Tunnel  Works,  Hamburg,  (two  atmospheres),  with  the 
following  results : 


Days 

Workers 

Cases  of  Illness 

20  stage 

526 

15 

16  uniform 

528 

17 

18  stage 

529 

12 

16  uniform 

629 

14 

14  stage 

536 

12 

The  percentage  on  the  basis  of  man-shifts  for  the  stage  method 
is  0.15;  and  for  the  uniform  method  0.19.  These  results  show  only 
a  slight  advantage  for  stage  decompression,  but  they  are  not  con- 
clusive. 

It  would  seem,  then,  that  in  the  case  of  men  working  long  periods 
in  compressed  air  in  pressures  above  20  Ibs.,  the  question  of  the  time 
taken  for  decompression  is  of  more  importance  than  the  question 
of  the  method  of  decompression.  Hill  claims  that  exercise  and  the 
breathing  of  oxygen,  both  of  which  aid  in  the  elimination  of  nitrogen 
gas,  during  decompression  will  safely  permit  of  the  reduction  by 
at  least  one-half  of  the  times  of  decompression  advocated  by  Hal- 
dane. 

In  the  Pennsylvania  East  River  Tunnels,  during  a  period  of  five 
hundred  and  fifty-seven  days,  with  about  one  thousand  men  a  day 
working  in  compressed  air  at  pressures  varying  from  15  Ibs.  to  36 
Ibs.,  and  a  decompression  period  at  the  rate  of  one  minute  for  each 
two  pounds  of  pressure,  there  were  reported  to  the  medical  depart- 
ment 3692  cases  of  compressed-air  illness  with  twenty  deaths.  About 
ten  thousand  different  men  in  all  worked  during  this  time.  On  the 
basis  of  the  number  of  men  working,  the  percentage  of  illness  was 
36.92  and  the  percentage  of  fatal  cases  0.2.  On  the  basis  of  man- 
shifts, estimating  one  thousand  men  a  day  for  five  hundred  and 
fifty-seven  days,  or  557,000  man-shifts,  the  percentage  of  illness  was 
0.66  and  the  percentage  of  death  0.0035.  The  substitution  of  the 


Compressed- Air  Illness  199 

rate  of  decompression  now  required  by  the  New  York  State  law 
for  tunnel  work,  of  three  pounds  every  two  minutes  up  to  36  Ibs. 
and  of  one  pound  per  minute  for  pressure  above  36  Ibs.,  would  no 
doubt  have  reduced  the  number  of  cases  of  illness,  as  well  as  the 
number  of  serious  and  fatal  cases,  but  it  seems  highly  improbable 
that  it  would  have  prevented  all  illness  and  death. 

In  considering  the  etiology  of  compressed-air  illness  it  must  be  re- 
membered that,  beside  the  questions  of  pressure,  time  of  compression, 
and  rate  of  decompression,  there  are  many  other  factors  to  be  reck- 
oned with,  which  might  be  called  predisposing  causes.  Briefly  stated 
these  are  as  follows : 

[_Age. — Boys,  on  account  of  underdevelopment,  and  men  past  forty 
are  generally  acknowledged  to  be  bad  subjects  for  compressed-air 
work. 

Build. — Fat  individuals  are  bad  risks  in  compressed-air  work  and 
should  be  avoided. 

Organic  disease. — Persons  with  organic  disease  should  not  be  sub- 
jected to  work  in  compressed  air  because,  even  if  they  are  not  more 
susceptible  to  compressed-air  illness,  they  are  certainly  less  able  than 
those  with  normal  organs  to  stand  the  effects  of  such  illness. 

Alcoholism. — Alcoholics  are  bad  risks  for  the  same  reason  that 
those  with  organic  disease  are  bad  risks. 

Newness  to  work. — "Green"  men  are  more  likely  to  have  symptoms 
of  compressed-air  illness  than  old  workmen. 

Fatigue. — This  appears  to  play  a  decided  part  in  the  causation  of 
compressed-air  illness. 

Ventilation. — C  O2  within  reasonable  limits  probably  has  no  effect. 
Poisonous  gases,  such  as  C  O  and  H2S,  may  play  a  part  in  etiology. 

The  personal  element. — This  is  a  factor  which  I  believe  plays  a 
large  part  in  the  causation  of  compressed-air  illness.  I  have  used 
this  term  for  want  of  something  more  definite.  Just  what  conditions 
may  exist  to  make  certain  individuals  susceptible  to  compressed-air 
illness  or  to  cause  those  who  have  apparently  been  immune  suddenly 
to  develop  symptoms,  sometimes  serious,  I  cannot  say.  It  has  seemed 
to  me  probable  that  certain  individuals  may  lack  the  ability  to  ex- 
crete the  gases  from  the  blood  at  the  physiological  rate  during  decom- 
pression and  that  such  a  condition  may  arise  at  any  time  in  men  who 
have  been  free  from  it.  In  my  experience  I  have  found  that  certain 
men,  who  from  careful  examination  appeared  especially  fit  subjects, 


2OO  American  Labor  Legislation  Review 

fell  easy  victims  to  the  effects  of  compressed  air.  In  the  work  on  the 
Pennsylvania  East  River  Tunnels  several  old  workmen  had  fatal  ill- 
nesses while  working  under  apparently  the  same  conditions  under 
which  they  had  worked  safely  for  months. 

SYMPTOMS 

The  time  is  too  short  to  allow  of  a  detailed  report  in  this  paper 
of  the  symptoms  of  compressed-air  illness.  They  are  various  in 
form  and  depend  first  upon  the  amount  of  gas  set  free  in  the  blood, 
and  second  upon  what  organs  are  affected  by  the  gas  emboli.  In 
many  cases,  as  when  soft  tissues  or  unimportant  organs  are  in- 
volved, gas  emboli  will  give  no  symptoms.  A  small  gas  bubble 
causes  pain  when  present  in  some  unyielding  tissue,  such  as  nerve 
sheath  or  periosteum;  it  causes  vertigo  when  in  the  semicircular 
canal ;  paralysis  when  in  a  motor  area  of  the  spinal  cord ;  and  sud- 
den death  when  in  a  vital  center  of  the  medulla,  or  possibly  in  the 
coronary  artery.  Large  accumulations  of  gas  in  the  blood  stream 
cause  general  pains  and  prostration,  and  in  extreme  cases  collapse, 
coma,  and  sudden  death. 

In  my  study  of  3692  cases  I  made  the  following  classification, 
giving  the  number  and  percentage  of  cases  falling  under  each 
group,  as  follows: 

No.       Per  cent 
A. — Cases  shoiving  pain  in  various  parts  of  the 

body,  "bends" 3278       88.78+ 

Cases  with  pain  also  having  local  manifes- 
tations     9  .26+ 

B. — Cases  showing  pain  and  prostration 47          i  .26+ 

C. — Cases  showing  symptoms  referable  to  the 
central  nervous  system: 

1.  Brain  (hemiplegia) 4  .11  + 

2.  Spinal  cord: 

(a)  Sensory  disturbance  36 

(b)  Motor  disturbances    34 

(c)  Sensory  and  motor  disturbance  . .  10 

Total  (Spinal  cord)   80  2.16+ 

D. — Cases  showing  vertigo,  "staggers" 197  5-33+ 

E. — Cases  showing  dyspnoea  and  sense  of  con- 
striction of  the  chest,  "chokes" 60  1.62 


Compressed- Air  Illness  201 

F. — Cases  showing  partial  or  complete  uncon- 
sciousness with  collapse 17  46+ 


Grand  total    3692       99.98+ 

r  Group    B 6 

Fatal  Cases  J  Group    C 5 

[  Group   F 9 

20  or  .54+  per  cent. 

PATHOLOGY 

The  results  of  autopsy  in  fatal  cases  have  fallen  largely  under 
two  classes:  first,  those  which  died  after  long  illnesses  and  showed 
lesions  of  the  spinal  cord,  such  as  disseminated  and  transverse 
myelitis  and  hemorrhage,  with  consequent  complications,  such  as 
pneumonia,  cystitis,  pyonephritis,  bed  sores,  etc. ;  and  second,  those 
which  died  soon  after  decompression,  many  of  which  showed  the 
presence  in  greater  or  less  degree  of  free  gas  in  the  circulatory  sys- 
temn  Von  Schrotter,  in  an  analysis  of  one  hundred  and  thirty-seven 
fatal  cases  reported  between  the  years  1854  and  1897,  found  twenty 
reported  autopsies  showing  lesions  of  the  spinal  cord  and  their 
complications,  and  eighteen  reported  autopsies  in  rapidly  fatal  cases 
of  which  eleven  showed  the  presence  of  free  gas  in  the  circulatory 
system.  In  the  twenty  fatal  cases  reported  by  me,  five  fell  within 
the  first  group,  and  of  these  two  came  to  autopsy  and  showed  lesions 
of  the  cord  and  complications ;  fourteen  fell  within  the  second  group 
and  of  these,  in  twelve  autopsies  reported,  eight  showed  the  presence 
of  free  gas  in  greater  or  less  degree  in  the  circulatory  system.  In 
cases  of  sudden  death,  when  no  discoverable  lesions  have  been 
found,  it  seems  fair  to  suppose  that  death  has  been  due  to  the  in- 
volvement of  vital  centers  by  emboli  too  small  to  be  detected.  In 
several  of  our  fatal  cases  no  sign  of  organic  disease  could  be  found. 

TREATMENT 

Recompression  is  the  most  efficient  means  of  treatment.  This  was 
recommended  by  Pol  and  Wattelle  in  1854;  Bert  demonstrated  its 
value  in  animal  experimentation  about  1871 ;  and  Mr.  E.  W.  Moir 
made  the  first  practical  use  of  the  medical  lock  at  the  old  Hudson 


202  American  Labor  Legislation  Review 

River  Tunnel.  He  there  proved  its  efficiency,  thus  making  it  a 
necessary  equipment  in  caisson  and  tunnel  work. 

The  medical  air-lock,  as  used  on  the  Pennsylvania  East  River  Tun- 
nels, consisted  of  an  air-tight  steel  cylinder  about  six  feet  in  diameter 
and  twelve  feet  in  length,  closed  at  one  end.  At  the  other  end  was 
an  entrance  by  means  of  an  air-tight  door  which  opened  inwards. 
The  cylinder  was  divided  into  two  compartments  by  means  of  a 
transverse  partition,  which  had  a  door  opening  toward  the  inner 
compartment.  Compressed-air  pipes  and  outlet  valves  supplied  both 
chambers,  so  that  the  pressure  could  be  raised  or  lowered  from  either 
chamber.  This  arrangement  enabled  the  physician  or  attendant  to 
enter  or  leave  the  chamber  in  which  the  patient  was  being  treated 
without  disturbing  the  pressure  of  that  chamber.  Valves  were  also 
placed  outside  the  lock  so  that  the  pressure  could  be  regulated  from 
without.  The  inner  chamber  was  fitted  with  two  bunks,  one  on  either 
side,  upon  which  patients  could  lie,  and  with  electric  lights,  telephone, 
clock,  pressure  gage,  thermometer,  and  electric  heater.  A  means  of 
ventilating  the  inner  chamber  was  also  supplied.  Heavy  glass  win- 
dows were  placed  on  a  line  in  both  doors  so  that  one  could  watch 
from  outside  the  patient,  pressure  gage,  and  thermometer. 

Recompression  should  be  instituted  as  soon  as  possible  after  the 
appearance  of  symptoms,  the  pressure  being  raised  quickly  to  the 
working  pressure.  Relief  of  symptoms,  when  afforded,  usually 
occurs  before  this  point  is  reached.  Soon  after  reaching  full  tunnel 
pressure  decompression  should  be  begun  at  a  rate  not  less  than  one 
pound  per  minute,  and  in  severe  cases  much  more  slowly.  At  the 
Pennsylvania  East  River  Tunnels  we  thought  our  results  were  best 
when  decompression  was  made  rather  quickly  down  to  10  or  15  Ibs., 
and  then  continued  very  slowly.  During  decompression  the  patient, 
if  able  to  do  so,  should  move  about  and  exercise  the  affected  part. 
In  severe  cases  massage  and  passive  movements  should  be  admin- 
istered by  an  attendant,  and  in  unconscious  cases  artificial  respira- 
tion should  also  be  performed.  If  symptoms  return  after  one  recom- 
pression,  a  second  recompression  should  be  made.  We  sometimes 
had  to  recompress  three  or  four  times  before  permanent  relief  was 
obtained.  In  cases  of  simple  pain,  where  there  is  a  return  of  symp- 
toms after  recompression,  relief,  frequently  permanent,  may  be 
obtained  by  the  use  of  counter-irritation  with  linaments,  the  vibrator, 
or  the  Faradic  current,  or  by  hot  applications.  A  hot  bath  for  the 


Compressed- Air  Illness  203 

return  of  pain  after  recompression  is  beneficial,  but  would  hardly  be 
indicated  in  cases  where  there  is  prostration. 

The  results  of  treatment  in  3692  cases  in  the  Pennsylvania  East 
River  Tunnels  were  as  follows: 

In  3278  cases  of  pain  in  various  parts  of  the  body  about  90  per 
cent  got  relief  from  one  or  more  recompressions.  Recompression 
failed  to  give  any  relief  in  only  about  .5  per  cent  of  the  cases  of 
this  class,  and  in  some  of  these  the  failure  was  undoubtedly  due  to 
improper  recompression  or  to  failure  of  the  patient  to  exercise  while 
decompressing. 

In  forty-seven  cases  of  pain  and  prostration,  thirty-eight  were  re- 
lieved or  cured  by  recompression,  all  ultimately  recovering,  but  six 
had  only  temporary  improvement  and  died.  The  other  three  refused 
the  medical  lock,  and  recovered  after  illnesses  of  about  a  week. 

In  eighty  cases  with  symptoms  referable  to  the  central  nervous 
system  the  results  were  as  follows : — 

Four  cases  of  hemiplegia  were  all  cleared  up  permanently  by  re- 
compression;  of  thirty-six  cases  of  sensory  disturbance,  thirty-four 
were  relieved  by  recompression,  two  refused  the  medical  lock 
and  were  improved  by  medical  treatment ;  of  thirty- four  cases  of 
motor  disturbance,  partial  or  complete  paralysis  of  the  legs,  twenty- 
three  were  benefited  by  recompression  and  either  cleared  up  at  once 
or  recovered  later,  in  eleven  recompression  caused  no  improvement 
and  of  these  five  ultimately  died,  three  had  permanent  spastic 
paraplegia,  and  three  were  lost  sight  of;  of  ten  cases  of  sensory 
and  motor  disturbance,  nine  were  permanently  relieved,  and  one  was 
improved,  but  the  final  result  was  not  learned. 

In  one  hundred  and  ninety-seven  cases  showing  vertigo,  with  or 
without  vomiting,  pain,  prostration  and  dyspnoea,  one  hundred  and 
eight  had  complete  relief  from  recompression,  eighty-two  had  par- 
tial relief  from  recompression,  and  seven  refused  the  medical  lock. 

In  sixty  cases  of  dyspnoea  and  sense  of  constriction  of  the  chest, 
all  cleared  up  with  one  recompression  except  two  which  required  a 
second  recompression. 

In  seventeen  cases  of  partial  or  complete  unconsciousness  and 
collapse  eight  were  cured  or  relieved  by  one  or  more  recompressions, 
but  nine  had  little  or  no  relief  and  died.  Oxygen  given  to  several 
of  these  severe  cases  during  decomipression  afforded  no  appreciable 
benefit. 


204  American  Labor  Legislation  Review 

PREVENTION  OF  COMPRESSED-AIR  ILLNESS 

How  to  prevent  compressed-air  illness  is  a  most  important  ques- 
tion. Modern  demands  in  engineering  require  the  use  of  compressed 
air.  Recompression,  while  an  efficient  means  of  treatment  in  mild 
cases,  often  fails  to  prevent  disability  and  death  in  severe  ones.  If 
high  pressures  are  to  be  used,  all  means  should  be  employed  to 
prevent  illness.  These  should  consist  of  thorough  medical  examin- 
ations of  workmen  and  especially  of  new  candidates.  In  cases 
where  "green"  men  must  work  in  high  pressures,  25  Ibs.  or  over, 
preliminary  tests  should  be  given  and,  if  satisfactorily  passed,  a  short 
working  shift  should  first  be  tried.  Careful  supervision  of  the 
workmen  should  be  exercised,  and  occasional  reexaminations  made, 
especially  after  any  absence  from  work.  The  men  should  be  instruct- 
ed as  to  the  dangers  of  rapid  decompression,  should  be  made  to 
move  about  during  and  after  decompression,  and  should  be  warned 
that  neglect  to  seek  medical  advice  at  once  upon  the  appearance  of 
any  symptoms  may  result  disastrously.  They  should  also  be  in- 
formed of  the  bad  effects  of  excesses  of  all  kinds,  of  improper  hy- 
giene, and  of  intercurrent  illness. 

The  following  table  indicates  briefly  what  can  be  done  by  medical 
examination  and  proper  supervision  to  eliminate  the  predisposing 
causes  mentioned  under  the  subject  of  etiology : 
Predisposing  factors  Can  be  prevented 

Age  (improper)  Yes 

Build  (fat)  Yes 

Organic  disease  To  a  large  extent 

Alcoholism  To  a  large  extent 

Newness  to  work  Partly 

Fatigue  No 

Ventilation  (bad)  To  a  large  extent 

Personal  element  No,  not  with  our  present  knowl- 

edge. 

The  chief  means  of  preventing  illness  must  be  found  in  the  ar- 
rangement of  shifts  and  decompression  periods  to  suit  the  pressures. 
In  this  connection  we  find  the  old  conflict  between  labor  and  capital. 
The  workman  is  willing  to  reduce  the  shift  but  rebels  at  what  seems 
to  him  an  unnecessary  time  for  decompression.  The  contractor,  on 
the  other  hand,  desires  to  offset  long  shifts  by  long  decompressions. 

Laws  have  already  been  passed  in  different  countries  regulating 


Compressed-Air  Illness  205 

the  length  of  shifts  and  decompression  periods.  Such  a  law  has 
been  passed,  however,  in  but  one  state  (New  York)  in  this  country. 
As  time  goes  on  further  legislation  will  no  doubt  be  needed  and 
this  could  be  made  much  more  efficient  if  full  information  in  regard 
to  all  cases  of  compressed-air  illness  could  be  reported  to  the  state 
and  reviewed  by  some  competent  person  or  board,  who  should  recom- 
mend the  necessary  changes  in  the  laws.  What  is  now  most  needed 
is  an  exhaustive  study  of  the  practical  application  of  theories  which 
have  been  well  worked  out.  In  studying  the  causes  of  compressed- 
air  illness,  one  should  not  forget  that  many  factors  play  a  part,  and 
that,  since  the  human  organism  is  concerned,  it  is  not  a  purely  phy- 
sical question.  The  results  of  comparatively  few  experiments  with 
animals  should  not  be  looked  upon  as  final.  In  the  same  way,  the 
results,  under  certain  conditions,  with  a  comparatively  few  men 
should  not  be  considered  conclusive.  While  much  may  be  done  by 
proper  regulations  to  diminish  cases  of  illness  and  death  in  com- 
pressed-air work,  I  believe  that,  when  pressures  of  two  or  more  at- 
mospheres are  being  used,  it  should  be  classed  as  a  dangerous  occu- 
pation on  account  of  individual  conditions,  not  now  understood, 
which  I  have  called  the  personal  element. 


OCCUPATIONAL  SKIN  DISEASES 


JOHN  A.  FORDYCE 

University  and  Bellevue  Hospital  Medical  College. 


With  the  exception  of  certain  well-defined  types,  occupational  der- 
matoses  as  a  class  have  not,  in  this  country  at  least,  received  the 
attention  they  merit.  While  every  dermatological  clinic  numbers 
among  its  applicants  each  year  many  patients  in  whom  occupation 
has  a  direct  or  indirect  bearing  on  the  causation  of  their  eruption, 
it  is  difficult,  owing  to  lack  of  systematic  investigation,  to  give  a 
definite  idea  as  to  the  prevalence  of  skin  affections  in  the  various 
trades.  At  my  own  clinic  at  the  University  and  Bellevue  Hospital 
Medical  College  about  2  per  cent  of  the  total  number  of  new  cases 
for  1911  constituted  occupational  dermatoses.  The  great  majority 
of  these  were  of  the  type  known  as  trade  eczemas  and,  while  many 
cases  yield  readily  to  treatment  and  proper  preventive  measures, 
others  constitute  a  serious  inconvenience  from  an  economic  stand- 
point, sometimes  necessitating  a  complete  cessation  from  work  or  a 
change  of  occupation. 

Cutaneous  vulnerability  is  more  or  less  an  individual  peculiarity, 
for  while  persons  are  met  with  who  are  so  sensitive  to  an  irritant, 
physical,  chemical,  thermal,  or  actinic,  that  they  react  after  a  short 
exposure  or  contact  by  an  acute  dermatitis,  other  people  remain  en- 
tirely unaffected.  Occasionally  such  individuals  exhibit  so  high  a 
degree  of  sensitiveness  that,  instead  of  acquiring  an  immunity,  an 
increasing  susceptibility  is  established.  Fortunately  these  cases  are 
not  very  common  and  it  is  more  usual  to  see  workers,  though  sub- 
jected to  continuous  injury,  only  after  a  considerable  time  develop 
lesions,  either  from  the  summation  effects  of  the  irritant  or  because 
the  resistance  of  the  skin  has  been  gradually  undermined.  After 
such  a  cutaneous  outbreak  there  is  frequently  a  tendency  to  acute 
exacerbations  at  regular  intervals  or  when  the  occupation  is  resumed. 
These  eruptions  may  then  persist  for  years. 

While  the  skin,  both  anatomically  and  physiologically,  is  en- 
dowed with  a  relative  amount  of  protection  against  the  action  of  irri- 


Occupational  Skin  Diseases  207 

tant  substances,  by  reason  of  its  exposure  it  is  subjected  to  injuries 
of  every  description  and  these  may  lay  the  foundation  for  a  subse- 
quent eruption.  In  addition  there  are  other  contributing  factors, 
such  as  a  special  susceptibility,  a  delicate  skin  or  one  presenting 
some  congenital  anomaly,  as  excessive  dryness  or  ichthyosis,  impaired 
gastro-intestinal,  hepatic  or  renal  function,  a  depressed  state  of 
health,  neglected  hygiene  of  the  skin,  or  its  lowered  resistance  due 
to  a  preexisting  eruption. 

We  often  find  the  same  etiologic  factor  operative  in  both  allied 
and  unrelated  trades,  owing  to  similar  conditions  under  which  the 
work  is  done ;  for  example,  where  men  or  women  are  exposed  to  ex- 
cessively dry  or  moist  heat.  Such  an  atmosphere  leads  to  congestion 
and  interference  with  the  normal  activity  of  the  skin,  which  is  fol- 
lowed by  various  inflammatory  processes  and  sweat  eruptions  like 
prickly  heat.  These  affections  are  met  with  in  cooks,  stokers,  fire- 
men, foundry  workers,  etc.  A  warm,  moist  medium,  such  as  laun- 
dresses work  in,  sometimes  produces  a  cystic  condition  of  the  sweat 
ducts  of  the  middle  third  of  the  face,  known  as  hydrocystoma.  Cold, 
by  favoring  the  development  of  chilblains,  causes  much  suffering 
among  people  who  are  obliged  to  carry  on  their  work  outdoors  or 
in  poorly  heated  places.  In  factories  where  drastic  measures  are 
employed  for  the  removal  of  dirt  or  stains,  cleansing  agents  like 
chlorid  of  lime  or  benzine  used  on  the  hands,  by  divesting  the  skin 
of  its  natural  secretions,  supply  the  base  for  an  eczema.  Oil,  which 
is  used  wherever  machinery  is  installed,  is  the  causative  agent  of 
acneiform  and  eczematous  lesions  in  employees  who  operate  or  are 
otherwise  engaged  about  such  apparatus. 

In  occupations  which  necessitate  standing,  people  who  have  a 
tendency  to  varicose  veins  not  infrequently  exhibit  this  condition, 
with  a  secondary  eczema  and  ulceration.  Slight  traumatisms  lead  to 
erosions  of  the  skin,  which  often  become  infected  in  patients  who, 
owing  to  venous  congestion,  have  slight  resistance.  Young  women 
who  are  obliged  to  stand  at  their  work  sometimes  develop  erythema 
induratum  or  Bazin's  disease,  which  is  characterized  by  nodules  be- 
neath the  skin  that  may  break  down  and  produce  ulcers.  Some  of 
these  forms  of  Bazin's  disease  have  been  proved  to  be  tuberculous. 
The  infection  is  usually  of  benign  type  and  readily  yields  to  rest  in 
bed,  improved  nutrition,  and  a  change  to  better  hygienic  surround- 
ings. 


208  American  Labor  Legislation  Review 

Many  occupations,  without  being  pathological  in  the  strict  sense  of 
the  word,  bring  about  changes  in  the  skin  which  are  so  characteristic 
that  Blaschko1  has  given  them  the  name  of  trade  stigmata.  These 
include  localized  thickenings  of  the  horny  layer  in  shoemakers,  tai- 
lors, musicians,  etc. ;  bronzing  of  the  skin  in  gardeners,  farmers,  and 
other  people  who  follow  outdoor  occupations ;  staining  of  the  hands 
in  dyers,  chimney-sweeps,  etc.;  pigmentation  in  workers  in  silver 
from  a  deposit  of  the  latter  metal  and  in  millers  from  iron  par- 
ticles, etc. 

The  skin  responds  to  the  most  diverse  irritants,  on  the  one  hand 
by  the  production  of  a  catarrhal  inflammation,  and  on  the  other  by 
the  development  of  different  types  of  eruption  from  the  action  of 
the  same  agent.  Of  the  former  we  have  an  example  in  the  trade 
eczemas  and  of  the  latter  in  the  effects  of  working  with  tar,  where 
eczema,  acne,  warty  and  epitheliomatous  lesions  may  exist  alone  or 
intermingled. 

The  commonest  type  of  occupational  disease  is  an  eczematoid 
dermatitis.  In  a  recent  article  Herxheimer2  enumerates  seventy- 
four  trades  provocative  of  this  form  of  disease.  It  may  vary  in 
grade  and  intensity  from  an  erythematous  and  scaling  dermatitis  to 
a  vesicular  and  bullous  eruption.  As  the  condition  becomes  chronic, 
infiltration  of  the  skin  takes  place,  with  desquamation  and  fissuring. 
With  the  cutaneous  defenses  lowered,  pus  infection  is  frequently 
superadded. 

The  excessive  use  of  soap  and  water,  by  extracting  the  fat  and 
macerating  the  horny  cells,  reduces  the  resistance  of  the  skin.  These 
agents  may  then  act  as  direct  excitants  or  prepare  the  way  for  some 
other  irritant,  as  washing  powders,  etc.  Severe  eczemas  of  the 
hands  and  forearms  are  seen  in  those  whose  occupations  require 
them  to  have  their  hands  continually  in  water,  as  in  the  case  of 
washerwomen,  housemaids,  barkeepers,  etc.  In  my  clinic  nearly 
one-third  of  the  occupational  diseases  during  the  past  year  were 
seen  in  persons  whose  vocations  necessitated  the  frequent  employ- 
ment of  soap  and  water,  and  in  some  cases  of  the  various  cleansing 
alkalis. 

1  Blaschko,  "Gewerblichen  Hautkrankheiten."  Handbuch  der  Arbeiter- 
krankheiten,  Th.  Weyl-Gustav  Fischer,  1908. 

a  Herxheimer,  "Ueber  die  gewerblichen  Erkrankungen  der  Haut."  Deutsch. 
Med.  Wochenschr.,  1912,  Nr.  i. 


OCCUPATIONAL  SKIX   DISEASES 

1.  PAPILLCMA  CF  PALM  OF  THE  HAND  OF  AN  IRON-WORKER.     THREE  YEARS' 

DURATION.     LESION  is  DUE  TO  FRICTION  FROM  THE  TOOLS  OF  THE  TRADE 

2.  COMMON  TYPE  OF  CHRONIC  ECZEMA  OF  HANDS  AND  FOREARMS  FOLLOWING 

PROLONGED  CONTACT  WITH  IRRITANTS.     IN  THIS  CASE  THE  IKHFANT 

WAS  WOOD- ALCOHOL  USED  IN  THE  PREPARATION*  CF  VARNISH 


Occupational  Skin  Diseases  209 

In  bakers  a  form  of  dermatitis  of  the  hands  and  forearms  is 
known  as  baker's  itch.  The  exciting  causes  are  the  heat,  the  moist 
dough,  and  the  saccharine  solutions.  A  mite  said  to  live  in  flour 
has  also  been  incriminated.  Candy-makers  suffer  from  a  similar 
eruption,  as  well  as  from  impetiginous  lesions.  Confectioners,  bak- 
ers, and  preservers  of  fruit  frequently  show  an  eczema  of  the  fingers 
and  peri-ungual  tissues  from  the  action  of  fruit  acids. 

In  a  personal  communication,  Winfield  describes  a  dermatitis  in 
sugar-refiners,  which  involves  the  hands,  forearms,  and  legs,  and  re- 
sembles an  impetiginous  scabies.  It  has  been  claimed  that  a  mite 
found  in  raw  sugar  is  responsible,  but  this  lacks  verification.  Oliver3 
states  that  in  sugar  factories  a  condition  known  as  "lymphangitis  of 
sugar-makers"  is  sometimes  found  among  the  sugar-refiners  and 
molasses  stirrers.  It  is  accompanied  by  a  slight  constitutional  dis- 
turbance and  a  crop  of  boils  is  not  an  unusual  sequel.  According  to 
Gaillot  the  lymphangitis  is  a  Staphylococcus  pyogenes  aureus  infec- 
tion. This  organism  is  said  to  be  found,  not  in  the  freshly  made 
molasses,  but  in  the  residue,  and  the  temperature  of  the  factory  and 
the  condition  of  the  skin  favor  its  development. 

Builders  and  masons  develop  an  eczematous  affection  of  the  ex- 
posed parts  of  the  body  from  the  irritating  effects  of  lime  and 
cement.  In  stonecutters  an  analogous  condition  is  caused  by  the 
stone  dust.  A  palmar  dermatitis  is  also  seen  in  brickmakers.  Metal 
workers,  whether  from  the  constant  irritation  of  the  dust  or  filings, 
their  direct  cauterant  action,  or  that  of  acids  or  turpentine  used  in 
the  various  processes,  suffer  from  all  grades  of  inflammation  to  in- 
tractable ulceration.  Printers  and  machinists,  from  contact  with 
chemicals  and  oil,  often  develop  a  chronic  eczema  of  hands  and  fore- 
arms. Electroplaters  are  also  liable  to  an  inflammation  of  the  hands 
and  forearms  from  the  use  of  a  mixture  of  lime  dust  and  olive  oil  in 
"finishing"  and  of  sour  beer  in  the  process  known  as  "scratch  brush- 
ing." 

Workers  who  handle  the  chromates  in  the  arts  and  trades  suffer 
from  an  eczematoid  eruption,  as  well  as  from  ulceration  of  the  skin 
and  mucous  membrane,  which  shows  little  tendency  to  heal.  Hydro- 
fluoric acid,  employed  in  the  manufacture  of  glass,  the  bleaching  of 
cane,  the  washing  of  manure,  etc.,  produces  sores  of  the  nasal  ori- 
fice and  gums  and  painful  blisters  and  ulcers  of  the  skin. 

8  Oliver,  Diseases  of  Occupation.    E.  P.  Button  &  Co.,  1908. 


210  American  Labor  Legislation  Review 

The  irritant  action  of  arsenic  on  the  skin  is  well  known.  In  the 
arts  and  manufactures  where  its  compounds  are  employed,  workers 
are  attacked  with  eczema  or  ulcerative  or  gangrenous  lesions,  which 
may  be  present  on  the  face,  neck  and  extremities,  but  more  especially 
the  genitals.  In  color  works  ulcers  of  the  hands  are  designated 
"arsenic  pock."  The  sulfid  of  arsenic  which,  with  lime,  is  used  in 
curing  fur,  sets  up  a  very  severe  dermatitis  in  furriers,  not  infre- 
quently with  persistent  ulceration. 

Chemists  are  prone  to  inflammation  of  the  hands  and  sometimes 
of  the  face  from  handling  various  drugs  and  chemicals.  Their  skin 
often  develops  so  marked  a  susceptibility  that  minute  quantities  or 
even  fumes  will  call  forth  an  outbreak.  I  have  several  times  noted 
a  similar  anaphylactic  condition  from  formalin  in  laboratory  work- 
ers. Another  familiar  example  of  an  eczema  due  to  chemical  action 
is  that  of  the  hands  of  physicians  and  nurses  from  the  use  of  antisep- 
tics, notably  bichlorid  of  mercury  and  carbolic  acid.  These  forms 
of  dermatitis  are  very  rebellious  to  treatment. 

Among  miners,  smelter  workers,  and  photographers  an  eruption 
of  erythematous  and  pustular  type  is  sometimes  encountered  from 
the  irritant  effects  of  mercury.  Photographers  are  also  subject  to 
an  eczema,  more  especially  of  the  terminal  phalanges  and  nails,  from 
other  reducing  agents,  particularly  pyrogallic  acid. 

In  hat  factories  eczema  of  the  hands  is  said  to  result  from  the 
manipulation  of  hot  water  acidulated  with  sulfuric  acid.  The 
eczema  in  tobacco  workers  is  believed  to  be  due  to  the  caustic  solu- 
tions used  in  separating  the  tobacco  leaves.  Calico-printers  suffer 
from  eczema,  fissures  and  wounds,  which  often  become  infected. 
The  cause  here  is  referred  to  the  bleaching  and  cauterizing  substan- 
ces handled. 

In  flax  and  linen  workers  various  skin  affections  are  reported, 
among  them  a  follicular  eruption  due  to  the  oils  and  irritating 
materials  met  with  in  this  occupation.  In  Belgium  many  of  the  flax 
workers  show  a  peculiar  abrasion  and  ulceration  of  the  palmar  sur- 
face of  the  hands.  Fissures  form,  exfoliation  takes  place,  and 
when  the  deeper  structures  are  involved  the  condition  stimulates  a 
syphilitic  lesion.  An  eruption  resembling  smallpox  has  also  been  de- 
scribed on  the  forearms,  arms,  and  faces  of  workers  who  remove 
the  bobbins  from  spinning-frames.  From  the  pressure  and  friction 


Occupational  Skin  Diseases  21 1 

caused  by  pulling  threads  the  people  who  engage  in  this  part  of  the 
work  present  callosities  on  their  index  fingers. 

Callosities  of  the  palms  are  also  met  with  in  laborers,  engine 
drivers,  etc.  Among  miners  they  form  a  special  dermatosis  called 
"beat  hand."  Painful  thickenings  develop  over  the  regions  where 
the  handle  of  the  pick  makes  greatest  pressure,  along  the  bases  of 
the  ringers,  over  the  ball  of  the  thumb,  and  on  the  outer  side  of  the 
hand.  The  subjacent  tissue  becomes  inflamed,  and  not  infrequently 
is  further  complicated  by  suppuration.  To  this  condition  the  term 
"keens"  is  applied. 

Warts  sometimes  form  very  troublesome  lesions  on  the  palms  of 
people  engaged  in  manual  work.  In  some  cases  they  are  purely  epi- 
dermic growths ;  in  others,  where  the  epidermis  has  been  removed, 
the  underlying  tissue,  as  the  result  of  irritation,  becomes  the  seat  of 
exuberant  granulations  with  papillomatous  formation. 

Dyers  and  workers  in  anilin  colors  are  apt  to  develop  eczematoid 
and  pustular  eruptions  on  different  portions  of  the  body.  The  bad 
effects  are  not  limited  to  those  in  this  trade,  but  the  wearers  of 
clothing  prepared  with  certain  of  the  dyes  may  ultimately  be  the 
victims  of  a  severe  dermatitis.  The  black,  red,  and  orange-yellow 
pigments  are  particularly  irritating,  marked  inflammatory  reactions 
having  been  caused  by  socks,  gloves,  underwear,  and  shoes  so  colored. 
I  have  also  seen  unusually  severe  forms  of  eczematoid  dermatitis  in 
barbers  who  had  employed  proprietary  anilin  hair  dyes  on  their 
patrons.  It  is  not  an  uncommon  experience  in  dermatological  prac- 
tice to  be  consulted  for  a  dermatitis  of  the  face,  neck,  and  ears  which 
had  followed  the  application  of  various  of  these  hair  dyes.  In  sus- 
ceptible subjects  the  use  of  hair  tonics  may  produce  similar  trouble. 
Another  dermatological  condition  met  with  in  anilin  workers  is  a 
hyperidrosis  of  the  palms  due  to  washing  the  hands  with  chlorid  of 
lime  for  the  removal  of  dyes.  According  to  Blaschko  it  may  be  so 
intense  as  to  amount  to  a  flux.  The  affection  is  also  seen  in  chlorid 
of  lime  and  soda  workers. 

The  manufacture  of  chlorid  of  calcium  and  chlorid  of  sodium 
and  potassium  by  electrolysis  is  sometimes  attended  by  an  erythema- 
tous  and  edematous  inflammation  of  the  face  of  the  workmen  resem- 
bling erysipelas.  This  is  attributed  to  the  hypochlorite  of  soda  that 
is  formed.  With  the  subsidence  of  the  acute  process  an  acneiform 
eruption  is  left  behind,  the  so-called  chloracne.  This  is  the  com- 


212  American  Labor  Legislation  Review 

monest  cutaneous  malady  met  with  in  this  occupation  and  is  char- 
acterized by  the  early  development  of  blackheads  on  the  face,  trunk, 
and  extremities,  followed  by  a  grayish  discoloration  of  the  face. 
With  inflammation  and  suppuration  of  the  follicular  glands,  nodules, 
pustules,  boils,  and  disfiguring  scars  are  a  not  uncommon  sequel. 

Tar  and  paraffin  workers  develop  a  similar  eruption  which  may  last 
several  months  and  then  change  to  the  so-called  "tar  itch."  This  is 
accompanied  by  hyperkeratosis  and  increased  activity  of  the  seba- 
ceous glands,  forming  plaques  and  crusts,  with  the  further  develop- 
ment of  multiple  warts,  one  or  more  of  which  degenerate  into 
malignant  growths.  The  disease  affects  chiefly  the  hands,  forearms, 
and  scrotum.  It  progresses  slowly  and  in  many  instances  no  recur- 
rence takes  place  after  removal  of  the  epithelioma.  Oliver  cites  the 
case  of  a  man  aged  58  who  had  worked  among  coal-oil  and  tar 
products  for  thirty  years.  He  presented  numerous  indurated  patches,- 
some  of  which  had  ulcerated,  as  well  as  multiple  black  warts  and 
scars,  the  remains  of  old  ulcers.  On  the  other  hand,  his  son,  27 
years  old,  following  the  same  employment,  developed  a  malignant 
growth  of  the  forearm  which  necessitated  amputation.  Metastases 
of  the  axillary  and  cervical  lymph  nodes  took  place  and  the  patient 
succumbed  to  secondary  carcinosis. 

Cancer  in  chimney-sweeps  has  been  reported  chiefly  from  England. 
The  soot  produces  a  chronic  irritation  of  the  skin,  and  when  retained 
in  such  regions  as  the  folds  of  the  scrotum  causes  warty  growths 
which  become  epitheliomatous.  In  some  instances  the  hands,  arms, 
and  thighs  have  been  involved.  With  the  advent  of  machinery  for 
cleaning  chimneys  the  incidence  of  scrotal  cancer  has  been  markedly 
reduced.  It  is  reported  that  gardeners  who  employ  soot  for  the  pro- 
tection of  plants  from  slugs  show  in  a  like  manner  the  effects  of  this 
irritant  in  the  development  of  malignant  growths  of  the  hands. 

Gardeners  and  florists  frequently  suffer  from  some  form  of  in- 
flammation of  the  hands  and  arms  occasioned  by  contact  with  certain 
plants.  It  is  estimated  that  some  sixty  or  seventy  plants  possess 
this  irritant  action  and  the  power  to  induce  a  dermatitis.  The  more 
familiar  ones  are  poison-ivy,  poison-sumac,  primrose,  chrysanthe- 
mum, and  eucalyptus,  the  eruption  varying  from  a  simple  erythema  to 
marked  swelling,  with  the  formation  of  vesicles  and  bullae.  Not  only 
are  the  exposed  parts  involved,  but  the  affection  may  be  carried  by  the 
hands  or  clothing  to  other  portions  of  the  body.  It  is  probable  that 


Occupational  Skin  Diseases  213 

the  active  principle  in  the  majority  of  these  plants,  as  in  the  case  of 
Rhus  toxicodendron,  is  an  essential  oil.  Lacquer  which  is  obtained 
from  a  tree  belonging  to  the  genus  Rhus  produces  a  dermatitis 
either  by  direct  contact  or  through  the  fumes  from  evaporation.4 
The  symptoms  appear  in  a  few  hours,  and  consist  of  fever  and 
edema  of  the  skin  of  the  face,  limbs,  and  generative  organs,  nasal 
and  conjunctival  catarrh,  and  a  papular  eruption  of  the  legs  and  fore- 
arms. 

The  resinous  dust  of  certain  hardwoods,  like  teak,  ebony,  satin- 
wood,  rosewood  and  others,  will  occasionally  set  up  a  dermatitis  in 
carpenters  and  joiners.  In  teak  the  exciting  agent  is  believed  to  be  an 
essential  oil  derived  from  the  central  part  of  the  tree  and  present 
in  the  dust.  The  symptoms  are  sometimes  very  severe,  the  eruption 
becoming  generalized  and  accompanied  by  vomiting.  It  may  last 
for  several  months  and  is  quite  apt  to  recur  on  resumption  of  work. 

The  so-called  "polisher's  itch"  of  the  forearms  and  hands,  met  with 
in  furniture  polishers,  is  attributed  to  the  methyl  or  impure  alcohols 
present  in  varnishes  and  polishes.  Impure  benzine  and  turpentine 
used  for  cleansing  purposes  likewise  provoke  an  eczema  of  the  hands. 

In  individuals  who  follow  an  outdoor  occupation  the  uncovered 
portions  of  the  skin  sometimes  undergo  peculiar  degenerative 
changes.  Under  the  name  of  "sailor's  skin"  Unna  has  described  an 
affection  which  he  observed  chiefly  in  seafaring  men.  A  diffuse 
cyanotic  redness  not  unlike  chilblain  develops  at  first  on  the  ears,  on 
adjacent  parts  of  the  cheeks  and  temples,  on  the  backs  of  the  hands, 
and  on  the  fingers.  The  skin  then  becomes  mottled,  pigmented, 
rough,  and  hard,  and  in  places  papillomatous.  These  warts  may 
last  for  years  and  slowly  undergo  a  malignant  change.  A  similar 
condition  is  met  with  on  the  face,  neck,  and  hands  of  people  who 
follow  agricultural  pursuits.  The  cause  is  sought  in  the  actinic  rays. 
The  effect  of  light  on  the  skin  is  illustrated  in  X-ray  workers,  in 
whom,  unless  protected,  the  hands  become  the  seat  of  a  mild  erythem- 
ato-squamous  eruption,  more  or  less  persisent,  which  is  succeeded 
by  pigmentation,  telangiectases,  and  atrophic  wrinkling.  This  con- 
dition may  remain  unchanged,  or  keratoses  may  be  added,  which 
develop  into  epitheliomata. 

Drivers  and  coachmen  exposed  to  the  rigors  of  the  weather  are 

4  Castellani  and  Chambers,  "Lacquer  Poisoning."  Manual  of  Tropical  Med- 
icine, 1910,  p.  118. 


214  American  Labor  Legislation  Review 

often  the  subjects  of  the  severer  forms  of  rosacea.  The  use  of 
alcohol,  however,  to  which  many  of  these  people  are  addicted,  cannot 
be  wholly  ignored  as  a  contributing  etiological  factor. 

Certain  callings,  notably  those  dealing  with  dead  or  live  animals 
or  their  products,  favor  the  development  of  infectious  diseases. 
Owing  to  the  prevalence  of  pyogenic  organisms,  local  pus  infections, 
as  boils,  carbuncles,  impetigo  contagiosa,  or  cellulitis  are  not  infre- 
quently met  with  in  butchers,  slaughter-house  men,  and  other  indi- 
viduals who  handle  dead  animal  matter.  A  generalized  bullous 
dermatitis,  with  severe  constitutional  symptoms  and  a  high  mortality, 
has  also  been  observed.  The  starting  point  is  usually  an  infected 
wound.  Several  years  ago  Bowen6  pointed  to  a  possible  relationship 
between  these  cases  of  so-called  "acute  infectious  pemphigus"  and 
foot  and  mouth  disease  of  cattle,  as  he  had  observed  such  instances 
during  an  epizootic  of  the  latter  disease  in  New  England.  Foot  and 
mouth  disease  takes  place  by  inoculation  of  the  skin  or  mucous  mem- 
brane in  butchers,  dairymen,  stableboys,  and  drivers.  Herxheimer 
records  having  seen  a  case  in  a  horsedealer. 

The  parasitic  diseases  which  are  more  definitely  identified  with 
particular  avocations  are  tuberculosis,  anthrax,  glanders  and  actin- 
omycosis.  Inoculation  tuberculosis  occurs  in  its  simplest  form  as 
verruca  necrogenica  or  anatomical  tubercle.  It  is  encountered 
chiefly  among  medical  students,  physicians,  hospital  ward  attendants, 
and  butchers  as  a  localized  papillomatous  formation  usually  about 
the  knuckles  or  other  parts  of  the  hand  or  forearm. 

Anthrax  is  very  uncommon  in  this  country,  but  it  is  very  preva- 
lent in  animals,  especially  cattle  and  sheep,  in  certain  parts  of  Europe 
and  Asia.  In  man  the  disease  occurs  as  the  result  of  direct  infection 
from  such  animals  or  their  products,  via  the  skin,  the  intestines,  or 
more  rarely  the  lungs.  It  is  met  with  in  the  wool-sorting,  wool- 
combing  and  spinning  industries,  in  horse-hair  and  brush  factories, 
in  stevedores,  wharf-laborers,  carters,  farmers,  shepherds,  butchers, 
meat  inspectors,  and  cattle  salesmen.  The  internal  form  is  known  as 
"wool-sorter's  disease."  Of  the  external,  which  is  also  the  more 
usual,  there  are  two  varieties,  the  malignant  pustule  and  malignant 
anthrax  edema,  the  latter  of  which  is  the  more  fatal  of  the  two. 

6  Bowen,  "Acute  Infectious  Pemphigus  in  a  Butcher  During  an  Epizootic 
of  Foot  and  Mouth  Disease  with  a  Consideration  of  the  Possible  Relation- 
ship of  the  Two  Affections."  Journ.  Cutaneous  Diseases,  1904,  vol.  xxii,  p. 
253. 


Occupational  Skin  Diseases  215 

Glanders,  usually  contracted  from  horses,  is  seen  almost  exclu- 
sively in  hostlers  or  those  who  have  to  do  with  these  animals.  It 
is  rare  in  this  country.  The  bacillus  may  gain  entrance  through 
the  mucous  membrane  of  the  eye,  nose,  mouth,  or  respiratory  tract, 
or  the  site  of  inoculation  may  be  a  lesion  of  the  skin.  Clinically  the 
disease  is  divided  into  glanders  and  farcy,  according  to  whether  the 
lesions  of  the  mucous  membrane  or  skin  predominate.  Both  types 
present  an  acute  and  a  chronic  form. 

Actinomycosis  is  endemic  in  cattle  and  more  rarely  affects  horses, 
hogs,  and  other  animals.  In  man  the  disease  is  seen  in  those  who 
come  in  contact  with  such  animals  or  who  handle  fodder  or  grain,  as 
farmers,  coachmen,  dairymen,  millers,  etc.  Infection  in  man  takes 
place  through  a  carious  tooth  or  a  lesion  in  the  mouth,  and  less  often 
through  the  skin.  The  ray  fungus  is  believed  to  flourish  on  corn, 
hay,  and  cereal  grains,  as  the  latter  has  frequently  formed  the 
nucleus  of  an  actinomycotic  lesion. 

Erysipeloid,  an  infection  of  the  skin  caused  by  poisoning  from 
meats,  fish,  poultry,  cheese,  and  similar  animal  products,  is  seen 
chiefly  in  butchers,  fishmongers,  poultry  dealers,  cooks  and  scullions. 
From  Gilchrist's6  observations,  crab  bites  and  injury  by  crabs  are  a 
frequent  cause.  The  disease  is  believed  by  Rosenbach  to  be  due  to 
a  micro-organism  of  the  order  Cladothrix.  It  is  characterized  by 
one  or  more  areas  of  slowly  spreading  inflammation,  clearing  up  at 
the  part  originally  affected  and  progressing  slowly  to  new  areas,  the 
advancing  border  being  festooned  or  scalloped.  Burning,  pricking, 
or  itching  sensations  accompany  the  affection,  which  involves  chiefly 
the  fingers  and  hands. 

Among  the  minor  infections  may  be  mentioned  ringworm  trans- 
mitted from  horses,  dogs,  and  other  domestic  animals  to  men  and 
boys  employed  about  stables  or  engaged  in  the  care  of  such  diseased 
animals.  Ringworm  of  equine  origin  is  characterized  by  the  forma- 
tion of  irregular  and  projecting  nodular  lesions  studded  with  pus- 
tules involving  the  beard  region,  neck,  wrist,  or  hands. 

In  certain  grain  regions  infested  by  a  mite,  Pediculoides  ventri- 
cosus,  an  intensely  itching  urticarioid  eruption  is  epidemic  among  the 
farmers  and  laborers  who  handle  sacks  of  wheat,  barley,  and  other 

'Gilchrist,  "Erysipeloid,  with  a  Record  of  329  Cases,  of  Which  323  were 
Caused  by  Crab  Bites  or  Lesions  Produced  by  Crabs."  Journ.  Cutaneous 
Diseases,  Vol.  xxii,  1904,  p.  507. 


216  American  Labor  Legislation  Review 

grains  or  straw  harboring  this  parasite.  Small  epidemics  have  also 
appeared  at  different  times  from  the  use  of  mattresses  made  from 
straw  on  which  the  organism  had  made  its  habitat.  To  Dr.  Jay  F. 
Schamberg7  belongs  the  credit  of  priority  in  describing  the  affection 
in  this  country. 

In  conclusion,  while  many  of  the  industrial  dermatoses  lead  to 
little  inconvenience,  some  forms  of  dermatitis  may  become  so  severe 
that  they  absolutely  prevent  a  man  from  carrying  on  his  occupation. 
In  certain  susceptible  individuals  the  action  of  the  irritant  is  not  con- 
fined to  the  parts  exposed,  but  may  spread  over  the  entire  body. 
Where  patients  develop  such  an  idiosyncrasy  they  should  be  guarded 
against  these  forms  of  dermatitis  becoming  permanent,  and  should 
be  advised  as  to  the  best  means  of  prevention.  Such  measures  cannot 
be  discussed  at  length  in  a  paper  of  this  scope,  as  they  must  neces- 
sarily fit  individual  cases.  If  the  nature  of  the  work  permits,  the 
wearing  of  masks  and  gloves  to  protect  the  exposed  parts,  as  prac- 
tised by  Chinese  lacquerers,  is  advisable,  but  obviously  this  is  not 
feasible  in  all  forms  of  occupation.  The  use  of  soap  and  water  is  to 
be  recommended  in  some  trades  in  order  to  remove  the  noxious  sub- 
stances ;  while  in  those  instances  where  they  prove  the  irritants  they 
are  positively  injurious  and  should  be  sparingly  used.  In  any  case, 
after  washing,  the  hands  should  always  be  very  carefully  dried  and, 
if  practicable,  covered  with  a  protective  ointment,  or  a  salve  or  cold 
cream  should  be  thoroughly  rubbed  into  the  skin  at  night.  People 
whose  vocations  bring  them  in  contact  with  live  or  dead  animals  or 
their  products  should  be  instructed  as  to  the  mode  of  inoculation  of 
infections  from  these  sources,  and  all  wounds  or  breaks  in  the  con- 
tinuity of  the  skin  should  be  sealed  with  collodion,  plaster,  or  some 
other  protective  dressing. 


1  Schamberg,  "Grain  Itch  (Acaro-Dermatitis  Urticarioides)  :  A  Study  of  a 
New  Disease  in  this  Country."  Journ.  Cutaneous  Diseases,  1910,  Vol.  xxviii, 
p.  67. 


OCCUPATIONAL  NERVOUS  AND  MENTAL  DISEASES 


CHARLES  L.  DANA 

Cornell  University  Medical  College. 


The  nervous  and  mental  diseases  which  may  be  called  occupa- 
tional are  brought  about  by  one  or  more  of  three  agencies:  (i) 
The  occupation  itself  may  be  such  as  directly  to  cause  damage 
to  the  nervous  tissues,  as  when  a  cigarmaker  gets  a  cramp  or 
neuritis,  or  a  painter  or  worker  in  a  lead  factory  gets  an  arm  paraly- 
sis. This  is  a  direct  occupational  disease.  (2)  The  occupation 
may  be  such  that  exposure  and  the  mode  of  work  or  life  almost 
necessarily  involve  risks,  temptations,  or  accidents  which  lead  to 
disease.  Thus  cab-drivers  surfer  from  occupational  alcoholism,  and 
soldiers  in  time  of  war  and  millworkers  on  very  long  hours  suffer 
from  occupational  insanities  of  various  kinds.  These  may  be 
called  indirect  occupational  neuroses  or  psychoses.  (3)  Nervous 
diseases  may  develop  when  work  is  carried  on  under  such  depressing 
conditions  of  meager  wages  or  insanitary  and  unwholesome  fac- 
tory and  home  life  that  ill  health  necessarily  follows.  These  may 
be  called  industrial  neuroses  and  psychoses.  With  this  broad  view 
of  the  nervous  diseases  of  occupations  one  can  see  that  the  subject 
is  not  easily  exhausted. 

DIRECT  OCCUPATIONAL  NERVOUS  DISEASES 

The  direct  occupational  nervous  diseases  are  quite  numerous. 
They  take  the  form  of  paralysis,  atrophy,  inflammation  of  the 
nerves  of  the  arm  or  leg,  neuralgia,  paresthesia,  and  dysesthesia 
(disagreeable  numbness,  prickling,  tingling,  etc.).  In  most  skilled 
workers,  and  in  all  kinds  of  workers  who  do  one  skilful  act  over  and 
over  again  for  long  periods  of  time,  we  have  the  occupational 
cramps;  writer's,  telegrapher's,  musician's,  pianist's,  etc.  Though 
about  ninety  per  cent  of  these  troubles  affect  the  arms  and  hands,  the 
legs  are  also  affected,  and  we  have  paralysis  and  pains  in  tailors, 
gardeners,  and  potato  diggers,  besides  the  more  serious  paralysis  of 
the  legs  in  caisson  disease.  The  occupations  which  involve  long 


218  American  Labor  Legislation  Review 

periods  of  standing  also  cause  various  foot-pains,  due  usually  more 
strictly  to  mechanical  disturbances  of  the  ligaments,  bones,  and  mus- 
cles than  to  nerves.  Policemen,  soldiers,  and  letter-carriers  have 
podalgia,  sciatica,  and  other  painful  troubles.  The  nerves  of  the 
head  are  least  often  involved,  but  miners  suffer  from  nystagmus, 
boilermakers  and  rivetters  from  deafness,  and  workers  with  strong 
arc-lights  from  paralysis  of  the  accommodation  or  light  reflex 
muscles. 

The  general  facts  about  these  troubles  were  set  forth  by  Dr.  Starr 
and  myself  in  papers  read  before  the  Academy  of  Medicine  and 
published  in  the  Medical  Record  of  February  3,  1912.  It  was 
shown  that  among  occupational  nervous  diseases,  the  most  serious 
and  frequent  were  those  due  to  lead  poisoning;  and  it  has  been 
shown  by  Dr.  Alice  Hamilton  that  lead  is  used  and  lead  poisoning 
may  occur  in  one  hundred  and  eleven  different  trades.  Arsenic, 
which  is  used  in  the  furrier's  trade  and  twenty-six  others,  is  much 
less  often  a  cause  of  nervous  disease,  but  it  has  been  in  the  past  an 
important  source  of  danger  in  the  manufacture  of  wall-papers  and  in 
beer  making.  Mercury  and  brass  occasionally  cause  symptoms  of 
nervousness,  tremors,  and  asthenic  and  anemic  states. 

The  number  of  occupations  in  which,  by  reason  of  mistake  or 
overuse  of  the  hands  and  arms,  we  find  neuritis,  neuralgia,  and 
cramps,  is  very  large.  I  gave  a  list  of  twenty  such  occupations 
in  my  previous  paper.  In  a  Paris  thesis,  1901,  under  the  title 
Occupational  Neuritis,  Dr.  Helene  R.  Baraks  gives  a  list  of  one 
hundred  and  nineteen  different  occupations  in  which  inflammation 
of  some  nerves,  mainly  those  of  the  arm  and  shoulder,  was  due  to 
the  work  in  which  the  persons  were  employed.  She  reports  over 
two  hundred  cases  illustrating  the  different  conditions.  Bruising 
and  pressure  on  the  parts  and  overwork  are  the  immediate  causes. 
In  New  York  the  occupations  which  contribute  most  often  to  these 
troubles  are  those  of  tailors,  cutters,  ironers,  pressers,  laundry 
workers,  musicians  (pianists  and  violinists),  porters  and  other  car- 
riers of  heavy  weights,  stenographers,  telegraphers,  and  bookkeep- 
ers. 

The  occupational  nervous  troubles,  aside  from  those  due  to  the 
caisson  disease  and  to  lead,  and  aside  from  the  cramps,  are  not  very 
serious.  They  are  curable  as  a  rule  in  a  few  months.  In  rare  cases, 
however,  they  pass  on  to  serious  and  progressive  organic  disease 


Occupational  Nervous  and  Mental  Diseases  219 

(atrophy  or  sclerosis).  These  troubles  are  caused  partly  by  care- 
lessness and  uncleanliness  and  perhaps  more  often  by  prolonged  and 
excessive  work. 

If  I  were  to  single  out  any  one  point  for  special  attention  and 
action,  I  should  advise  that  short  pamphlets  be  written  to  be  cir- 
culated among  ironers,  pressers,  tailors  and  especially  cutters,  cigar- 
makers,  masons,  and  boilermakers,  whose  work  involves  heavy,  reg- 
ular manual  movements;  and  also  among  workers  in  compressed 
air  and  those  who  have  to  handle  arc-lights,  cautioning  them 
against  the  dangers  and  showing  how  they  may  be  avoided.  The 
dangers  of  lead,  mercury,  arsenic,  phosphorus  and  caisson  work 
have  already  been  fully  explained.  The  remedies  have  only  to  be 
applied. 

Summing  up,  one  may  say  that  the  principal  occupational  ner* 
vous  diseases  are : 

1.  Toxic:  Lead  palsies,  neuralgias,  psychoses. 

Arsenical  palsies. 
Mercurial  tremors,  etc. 

2.  Mechanical:  Paralyses,  neuritic  and  atrophic. 

Atrophies. 

Parasthesias. 

Neuralgias. 

Spasmodic  disorders. 

Caisson  paraplegia  (the  "bends"). 

3.  Environmental:     Exhaustion  (auto-toxaemia). 

(Neurasthenia,  psychasthenia,  insanity). 

MENTAL  DISTURBANCES  DUE  TO  OCCUPATIONS 
The  occupational  psychoses,  or  mental  disturbances  due  to  occupa- 
tions, furnish  practically  an  unexplored  field  and  perhaps  not  a 
fruitful  one.     That  is  to  say,  occupation  is  essentially  a  healthful 
thing,  much  more  so  than  recreation  or  rest ;  and  I  would  urge  that 
the  aim  of  the  social  and  industrial  reformer  be  not  to  lessen  oc- 
cupation, but  to  make  it  easier  and  more  agreeable,  or  at  least  more 
interesting.    There  is  nothing  so  mentally  healthful  as  work. 
There  are,  consequently,  very  few  occupations  which  directly,  by 


220  American  Labor  Legislation  Review 

reason  of  the  kind  of  work,  cause  insanity.  Nevertheless,  there  is  a 
lead  insanity,  an  alcoholic  insanity,  and  an  insanity  caused  by  sulfid 
of  carbon  and  by  sulf  ureted  hydrogen ;  also  perhaps  a  mental  deteri- 
oration, especially  of  memory,  in  those  exposed  to  CO2.  Then 
there  are  certain  occupations  which  are  in  their  nature  exciting  or 
one-sided  in  their  demands  on  the  mental  life,  and  Dr.  T.  H.  Kel- 
logg enumerates  soldiers  (and  sailors),  poets,  prostitutes,  and  poli- 
ticians as  being  especially  liable  to  insanity.  To  this  list  others 
have  added  the  occupations  of  cab-driver,  stoker,  and  bartender. 
Millworkers  who  tend  machines  for  long  hours  are  said  by  Spoult- 
ing  to  contribute  unduly  to  the  state  hospitals  for  the  insane. 

The  insanities  due  indirectly  to  occupation  and  industrial  condi- 
tions are,  moreover,  very  numerous  and  important.  Forel  says: 
"Other  causes,  such  as  the  herding  together  of  the  proletariat  in 
great  cities,  in  bad  rooms  or  tenements  with  insufficient  food  and 
unhealthy  employment,  undoubtedly  weaken  the  nervous  system." 
And  Dr.  Kaplan,  in  enumerating  the  causes  of  that  devastating 
form  of  mental  degeneration,  dementia  praecox,  says: 

Most,  if  not  all,  of  my  patients  came  from  the  congested  districts  of 
Greater  New  York;  they  lived  in  tenement  houses;  they  were  deprived  of 
light,  proper  sanitation,  fresh  air,  and  good  food;  they  worked  in  sweatshops 
for  means  of  getting  their  livelihood;  they  were  in  constant  struggle  and 
strife  for  the  maintenance  of  their  existence.  Some  of  the  married  women 
were  compelled  to  work  in  shops,  in  addition  to  their  housework,  in  order  to 
support  the  family.  Seventy-two  patients  did  housework;  thirty-three  were 
employed  in  shops;  three  had  positions  in  stores;  eight  were  dressmakers; 
two  were  bookkeepers ;  three  stenographers ;  one  a  governess ;  one  an  attend- 
ant in  a  hospital  for  the  insane;  two  clerks;  one  a  student;  four  had  no  oc- 
cupation. 

INFLUENCE  OF  GENERAL  INDUSTRIAL  CONDITIONS 

All  this,  however,  is  in  a  way  only  incident  to  industrial  progress 
and  more  intense  social  activity.  The  occupation  of  becoming  high- 
ly civilized  leads  to  increase  of  insanity.  In  the  north  of  Italy, 
among  the  active  industrial  population,  says  Tanzi,  the  percentage 
of  insanity  is  25.3  per  10,000.  In  southern  Italy  it  is  1.3  to  6.6 
per  cent.  Crowd  people  together  and  there  surely  will  be  more 
insane.  Occupations  compelling  life  to  be  lived  under  congested 
conditions  are  thus  indirectly  the  cause  of  insanity.  If  we  wish 
to  improve  industrial  conditions  with  a  view  to  improving  mental 


Occupational  Nervous  and  Mental  Diseases  221 

health,  we  should  discourage  urban  industries,  especially  urban  fac- 
tories. 

This  is  not  because  of  the  industries  or  the  factories,  so  much 
as  it  is  because  of  the  mode  of  living.  What  is  the  use  of  high 
wages  and  short  hours  if  life  away  from  work  is  unhealthful  ?  The 
occupation  of  making  shirtwaists  may  keep  one  well  or  drive  one 
insane,  according  to  the  nature  of  the  home  and  the  kind  of  rest 
and  amusements  which  are  taken.  But  we  should  also  discourage 
industrial  isolation.  Man  needs  social  life  as  much  as  he  does 
fresh  air  and  good  food.  Men  are  like  certain  trees  which  do 
best  when  they  are  planted  just  so  far  apart;  not  too  close,  for  then 
the  roots  encroach  and  rob  each  other  of  nourishment;  and  not  so 
far  apart  that  there  is  no  support  and  protection  from  the  sun  and 
winds. 

The  active  money-earning  occupations  of  life,  then,  have  really 
little  in  themselves  to  do  with  causing  the  great  mass  of  nervous 
and  mental  disorders.  It  is  what  is  done  between  times,  what 
kind  of  rest  is  taken,  and  what  kind  of  home  life  is  lived.  It  is 
this  which  does  the  harm.  Women  have  many  more  nervous 
troubles  than  men,  but  they  have  fewer  occupations  and  the 
fewer  they  have  the  more  they  get  nervous.  It  is,  then,  I  repeat, 
not  occupations  themselves,  but  the  industrial  and  domestic  con- 
ditions to  which  working  people  are  subjected  which  cause  the 
mass  of  nervous  and  mental  diseases. 

Take  a  man  or  a  woman  and  make  him  or  her  do  a  dexterous 
piece  of  work  over  and  over  again  during  long  hours  and  under 
a  nervous  strain.  Underfeed  a  little,  shorten  or  disturb  the  sleep,  I 
and  you  can  produce  neuralgia  or  neuritis  or  a  cramp  within  from 
two  to  three  months.  Take  a  person  who  has  not  a  very  stable 
nervous  system  and  put  him  at  work  for  long  hours,  at  tasks  of 
concentration  or  skill.  Let  him  have  no  real  recreation  and  not 
quite  enough  restful  sleep  and  you  can  produce  a  mental  trouble 
of  at  least  a  minor  type. 

Those  who  work  on  a  certain  tension,  like  mill  operatives  in 
charge  of  machinery,  engineers,  etc.,  and  those  who  work  always 
with  a  strain  and  effort  to  finish  a  certain  fixed  amount  in  a  fixed 
time,  get  nervous  or  mental  troubles  unless  they  have  periods  of 
real  recreation.  Real  play  is  needed  for  hard,  tense  work.  For 
the  ordinary  worker  it  is  not  so  important.  Scientific  manage- 


222  American  Labor  Legislation  Review 

ment,  therefore,  which  speeds  up  the  human  machine,  must  give 
it  longer  rest  and  an  absolute  change  of  nervous  and  mental  in- 
terest. 

The  direct  occupational  causes  of  mental  diseases  are,  then,  of 
small  importance.  The  industrial  causes,  however,  which  lead  to 
bad  home  conditions,  bad  forms  of  recreation  and  rest,  bad  social 
and  moral  conditions,  are  of  immense  and  fundamental  impor- 
tance. We  could  lessen  insanity  more  by  razing  tenement-houses 
than  by  shortening  hours  of  labor.  Occupation  is  mentally  health- 
ful; play  may  be  exhausting  and  dangerous.  Give  the  hard- 
working man  knowledge  and  opportunity  to  spend  his  leisure  well, 
just  as  seriously  and  just  as  quickly  as  you  give  him  more  leisure. 
Some  legislation,  but  much  more  ordinary  good  sense  and  sanitary 
rules  should  be  preached.  I  would  say,  then,  in  conclusion,  that 
occupational  and  industrial  nervous  diseases  call  for  special  atten- 
tion on  the  part  of  the  sanitarian  a^d  of  the  legislator. 


OCCUPATIONAL  EYE  DISEASES 


ELLICE  M.  ALGER 
New  York  Postgraduate  Medical  School. 


If  we  are  to  judge  from  the  relative  space  assigned  to  them  in 
our  books,  the  importance  of  occupational  diseases  of  the  eyes  has 
not  been  properly  estimated.  There  are  many  industries  which 
regularly  cause  serious  organic  diseases  of  the  eyes  while,  in  the 
wider  sense,  there  are  few  skilled  occupations  in  which  the  eyes  are 
not  used  far  beyond  nature's  intentions,  with  corresponding  discom- 
fort and  disability.  I  have  no  intention  of  giving  you  a  catalogue 
of  the  rare  diseases  which  have  been  observed  from  time  to  time 
in  connection  with  our  modern  highly  specialized  industries,  but  I 
do  wish  to  call  your  attention  to  several  distinct  types  of  occupa- 
tional disease  and  to  assure  you  that  of  each  variety  there  are 
numerous  subvarieties. 

EXPOSURE  TO  INJURIOUS  SUBSTANCES 

Trade  accidents  should  not,  of  course,  be  classed  as  trade  dis- 
eases, whether  of  the  eye  or  of  other  organs.  It  is  very  difficult, 
however,  to  draw  any  hard  and  fast  line  between  the  occasional 
injuries  which  must  be  classed  as  accidents,  and  those  which,  like 
injuries  from  dust,  are  due  to  constant  exposure  to  injurious  sub- 
stances and  must,  therefore,  be  assumed  as  conditions  of  the  in- 
dustry. To  lose  an  eye  from  the  impact  of  a  popping  cork  is 
doubtless  an  accident,  though  not  by  any  means  so  rare  a  one  as 
you  might  suppose.  But,  in  the  bottling  industries,  accidents  of  this 
sort  happen  so  regularly  that  they  have  to  be  considered  as  inci- 
dents of  the  trade  and  guarded  against  accordingly.  The  same 
may  be  said  of  the  bursting  of  unprotected  water  gages  and  of 
other  similar  accidents  which  so  often  destroy  the  eyes  of  engi- 
neers and  machinists.  The  daily  total  of  more  or  less  dangerous 
injuries  to  the  eyes  of  workmen  is  something  enormous. 


224  American  Labor  Legislation  Review 

Consider  the  men  employed  in  the  various  grinding  trades.  In 
working  over  an  emery  wheel,  for  instance,  there  is  a  constant 
stream  of  small  particles  thrown  off  at  great  speed.  The  experi- 
enced man  has  learned  to  save  his  eyes  as  much  as  possible,  but  the 
beginner  is  always  in  trouble.  When  these  particles  are  small  they 
are  removed  from  the  eye  by  a  fellow  workman  with  the  corner  of 
a  dirty  handkerchief,  the  soft  end  of  a  chewed  toothpick,  or  the 
point  of  a  penknife.  Every  large  shop  has  some  man  who  is  par- 
ticularly expert  at  removing  these  foreign  bodies,  and  it  is  only 
when  they  are  too  deeply  embedded  for  the  amateur  operator's  skill 
that  they  are  referred  to  the  physician.  The  writer  often  sees  half 
a  dozen  or  more  cases  in  a  single  afternoon  in  his  dispensary  ser- 
vice, most  of  them  showing  signs  of  previous  manipulation. 
Considering  the  chances  for  infection,  bad  results  are  astonishingly 
rare.  Nevertheless,  there  are  many  cases  in  which  infection  does 
occur,  resulting  in  extreme  pain,  loss  of  time,  more  or  less  perma- 
nent disability,  and  most  infrequently  in  the  loss  of  the  eye  itself. 
It  must  not  be  forgotten  that  every  one  of  these  foreign  bodies, 
except  the  most  superficial,  produces  a  minute  but  permanent  opac- 
ity of  the  cornea,  which  if  rightly  situated  interferes  seriously  with 
sight.  I  have  seen  many  men  with  numerous  scars  in  each  eye  as 
the  result  of  repeated  injuries  of  this  kind,  and  yet  they  seem  to 
learn  nothing,  the  same  ones  coming  back  time  after  time  in  spite 
of  warning  and  advice.  The  various  safeguards  that  have  been 
devised  do  not  seem  to  be  practical,  for  opposition  to  their  use 
seems  to  come  from  the  men  rather  than  from  their  employers. 

Then  there  is  the  less  frequent  but  much  more  serious  list  of 
injuries  caused  by  the  larger  bits  of  metal  and  stone  in  foundries, 
quarries,  and  mines.  These  chips  fly  through  the  air  with  tremen- 
dous velocity  and  not  infrequently  pass  clear  through  an  eye.  These 
are,  of  course,  accidents  and  are  therefore  rather  outside  the  limits 
of  this  paper,  but  they  are  for  the  most  part  preventable  and  they 
should  be  prevented. 

There  are  many  other  trades  each  of  which  has  its  own  peculiar 
type  of  injury,  like  the  lime  burn  and  the  solder  burn.  Practically 
all  the  so-called  dusty  trades  cause  chronic  inflammation  of  the  eyes, 
which  not  only  makes  trouble  in  itself  but  predisposes  to  various 
infections.  Masons  and  plasterers  not  only  suffer  from  lime 
burns  but  commonly  have  chronic  conjunctivitis,  as  do  flour-mill 


Occupational  Eye  Diseases  225 

employees.  Hop  pickers  suffer  from  an  acute  inflammation  of  the 
conjunctiva  during  the  season,  and  farmers  and  other  outdoor  la- 
borers who  are  exposed  to  wind  and  dust  very  often  develop  ptery- 
gium. 

TRADE  POISONING 

There  are  also  many  trades  in  which  the  workmen  suffer  more 
or  less  permanent  loss  of  sight  through  the  absorption  of  drugs  of 
one  sort  or  another,  and  the  number  of  these  is  constantly  increas- 
ing as  the  complexity  of  our  manufacturing  processes  increases.  I 
have  no  intention  of  giving  you  a  list  of  all  the  chemicals  which 
are  on  record  as  having  produced  blindness.  The  list  is  a  long  one 
and  many  of  them  are  important  simply  as  suggesting  profitable  di- 
rections for  future  investigation.  Among  them  are  tobacco ;  alcohol ; 
lead,  used  in  so  many  different  industries;  bisulfid  of  carbon,  used 
in  the  manufacture  of  rubber ;  nitrobenzol,  used  in  the  manufacture 
ofjexplosives ;  and  some  of  the  anilin  dyes. 

LThe  one  to  which  I  wish  particularly  to  draw  attention  is  methyl 
or  wood-alcohol.  Owing  to  its  low  price  it  has  very  largely  displaced 
grain  alcohol  in  manufacturing  processes.^  It  was  never  intended 
for  internal  use,  but  has  long  been  consumed  by  the  ignorant  and 
benighted  as  furnishing  a  cheap  and  very  potent  source  of  intoxica- 
tion. Such  sprees  often  end  in  death  and  more  often  in  a  specific 
type  of  blindness.  Since  attention  has  been  devoted  to  this  subject, 
it  has  been  found  that  in  susceptible  individuals  a  very  small  dose 
of  wood-alcohol  may  produce  permanent  total  blindness.  Ten  drops 
have  produced  this  effect  in  one  case.  Furthermore,  instances  are 
accumulating  in  which  the  same  result  has  followed  its  use  as  a  sub- 
stitute for  grain  alcohol  in  bathing  and  rubbing. 

But  the  fact  that  compels  us  to  class  wood-alcohol  blindness  with 
the  occupational  diseases  is  the  increasing  number  of  cases  in  which 
it  has  followed  mere  inhalation  of  the  vapor  for  a  comparatively 
short  period.  It  is  used  in  many  of  the  trades  as  a  solvent  of  shel- 
lac, as,  for  instance,  by  painters  and  hat  makers.  Many  typical  cases 
are  now  on  record  of  blindness  in  painters,  who  have  used  it  in  re- 
moving varnish  in  close  rooms  or  in  applying  shellac  to  the  inside 
of  beer  vats  and  the  like. 

There  are  probably  many  cases  of  wood-alcohol  poisoning  which 
are  entirely  unrecognized.  Tyson  reports  a  whole  room  of  girls  in 


226  American  Labor  Legislation  Review 

a  pencil  factory  who  suffered  from  ill-defined  disturbances  of  vision, 
among  other  symptoms.  It  was  finally  discovered,  almost  by  acci- 
dent, that  the  pencils  were  varnished  with  wood-alcohol,  and  with 
suitable  ventilation  the  trouble  disappeared. 

Apparently  there  is  no  valid  excuse  for  the  manufacture  of  wood- 
alcohol.  Its  actual  cost  is  much  greater  than  that  of  grain  alcohol, 
and  its  manufacture  results  in  the  denudation  of  mile  after  mile  of 
growing  timber.  To  facilitate  the  use  of  grain  alcohol  in  the  arts 
the  government  permits  the  sale  of  the  so-called  denatured  alcohol 
tax  free;  but  unfortunately  one  of  the  processes  of  denaturing  con- 
sists of  adding  ten  per  cent  of  wood-alcohol,  which  is  sufficient  to 
make  even  denatured  alcohol  dangerous  to  the  susceptible.  It  is, 
perhaps,  beyond  the  scope  of  this  paper,  but  Holden  has  recently 
called  attention  to  the  fact  that  many  retail  druggists  sell  wood-alco- 
hol over  the  counter  under  various  names,  not  only  without  any 
indication  of  its  poisonous  nature,  but  with  the  phrase  on  the  label 
"guaranteed  under  the  food  and  drug  act",  which  many  people 
understand,  not  as  a  guarantee  of  purity,  but  of  harmlessness. 

We  have  much  to  learn  about  the  subject  before  we  can  legislate 
intelligently.  The  manufacturers  claim  that  the  pure  wood-alcohol 
is  harmless,  the  poisonous  brands  being  those  incompletely  refined, 
while  even  the  latter  are  safe  enough  if  sufficient  ventilation  is  se- 
cured. 

DISABILITIES  DUE  TO  EXPOSURE  TO  LIGHT 

-- 

There  is  another  long  list  of  more  or  less  serious  disabilities  which 
result  from  exposure  of  the  eyes  to* artificial  light,  made  necessary 
by  our  modern  factory  conditions.  Electricians  are  dazzled  and 
sometimes  blinded  by  sudden  exposure  to  the  intense  light  caused 
by  blow-outs  and  short  circuits.  Too  intense  light,  like  that  of  the 
arc  lamp,  decomposes  the  visual  purple  faster  than  it  can  be  regen- 
erated and  causes  a  condition  of  retinal  exhaustion.  It  also  causes, 
in  the  effort  to  exclude  the  light,  a  constant  extreme  contraction  of 
the  pupil,  which  is  both  painful  and  fatiguing.  This  accounts  for 
the  asthenopia  which  is  so  common  in  many  trades  which,  like 
those  of  gilders,  metal  polishers,  and  glass  workers,  compel  a  close 
attention  to  polished  surfaces  which  reflect  light. 
-  The  modern  methods  of  industrial  lighting  have  made  the  com- 
position as  well  as  the  intensity  of  light  a  subject  of  great  practical 


Occupational  Eye  Diseases  227 

importance.  Incandescent  gas  and  electric  lights  contain  many  of  the 
violet  and  ultra-violet  rays,  which  are  not  only  useless  for  illumina- 
ting purposes,  but  are  capable  of  causing  effects  on  the  eye  not  un- 
like a  modified  snow-blindness.  The  worker  who  is  exposed  to 
them  day  after  day  often  develops  annoying  inflammations  of  the 
lids  and  conjunctiva,  and  also  often  suffers  from  asthenopic  symp- 
toms which  vastly  diminish  his  efficiency.  Furthermore,  their  ef- 
fect on  the  deeper  structures  of  the  eye  is  suspected  of  being  still 
more  serious.  The  refractive  media  of  the  eye  absorb  most,  if  not 
all,  of  these  ultra-violet  rays,  so  that  the  retina  suffers  little  harm, 
but  it  is  quite  possible  that  the  continued  process  of  absorption 
may  be  one  of  the  causes  of  cataract.  It  is  certain  that  stokers, 
bottle  makers,  glass-blowers,  and  others  who  are  continually  ex- 
posed to  very  intense  light  and  heat  have  an  enormously  increased 
liability  to  cataract.  One  foreign  observer  found  that  as  many 
as  40  per  cent  of  the  bottle  makers  in  one  establishment  showed 
evidences  of  cataract,  though  the  great  majority  of  them  were 
under  forty  years  of  age.  The  left  eye,  which  is  nearest  the  fire, 
was  invariably  affected  more  than  the  right. 

DISEASES  DUE  TO  OCCUPATIONAL  STRAIN 

There  is  also  a  very  large  group  of  diseases,  organic  or  functional, 
which  are  due  to  prolonged  use  or  excessive  strain  of  the  eyes.  The 
eye  is  one  of  the  most  complicated  organs  in  the  body.  Perfect 
single  vision  requires  not  only  two  good  eyes  but  their  complete  co- 
ordination, which  is  accomplished  by  the  joint  action  of  fourteen 
separate  muscles.  Four  of  the  twelve  great  cranial  nerves  are  de- 
voted exclusively  to  vision.  When  one  stops  to  think  that  most 
people  use  their  eyes  almost  constantly  and  that  many  tasks  involve 
a  continuous  strain  for  hours  at  a  time,  one  begins  to  understand 
why  vision  necessitates  expenditures  of  nerve  and  muscle  energy 
beyond  almost  any  other  function. 

There  are  at  least  three  distinct  types  of  eye  fatigue  which  show 
themselves  in  different  trades.  We  have  already  alluded  to  the 
retinal  fatigue  resulting  from  the  constant  watching  of  polished 
or  reflecting  surfaces,  resulting  in  the  asthenopia  of  gilders  and 
polishers.  Next  comes  the  muscular  fatigue  which  we  see  in  the 
trades  that  compel  the  constant  use  of  the  eyes  for  close,  fine  work. 
The  perfectly  normal  eye  sees  things  close  at  hand  only  by  a  process 


228  American  Labor  Legislation  Review 

of  accommodation  or  focusing,  which  is  a  muscular  effort  and 
which  produces  a  normal  fatigue.-  It  is,  therefore,  perfectly  possi- 
ble to  strain  healthy,  normal  eyes  by  overwork.  In  most  of  the  so- 
called  errors  of  refraction,  hyperopia,  astigmatism,  and  the  like, 
distinct  vision  is  only  possible  by  overaccommodation,  and  the 
individual  who  has  to  accommodate  too  much  naturally  becomes 
tired  sooner  than  he  otherwise  would.  Holden,  in  a  very  interest- 
ing paper,  calls  attention  to  the  fact  that  one  of  the  first  occupa- 
tional diseases  of  which  we  have  any  record  was  the  scholar's  dis- 
ease; his  headache,  his  eye  pains,  his  indigestion,  and  his  pessimism 
were  ascribed  to  his  sedentary  life  and  his  brain  work.  Many  of 
the  ills  which  the  scholar  endured  were  due  to  overuse  of  his  eyes 
and  are  to-day  relieved  by  the  use  of  suitable  glasses.  But 
the  scholar  no  longer  has  any  monopoly  of  either  the  symptoms  or 
the  life.  To-day  there  are  many  trades  in  which  the  workman  sits 
hour  after  hour  chiefly  engaged  in  watching  intently — a  task  which 
eventually  tires  even  the  normal,  healthy  eye.  And  among  the 
factory  workers,  badly  housed,  ill  fed  for  generations,  diseased, 
refractive  errors,  which  are  for  the  most  part  congenital,  are  not 
only  practically  universal,  but  often  so  great  that  they  cannot  be 
compensated  for  by  any  amount  of  strain. 

Consider  the  garment  workers,  for  instance.  They  all  suffer  from 
errors  of  refraction,  large  or  small.  They  have  less  than  the  nor- 
mal compensatory  powers  because  their  muscles  are  overworked 
and  badly  fed.  They  work  long  hours  in  close,  badly  ventilated, 
badly  lighted  rooms,  driven  to  the  utmost.  The  least  muscular  re- 
laxation means  indistinct  vision  and  mistakes  in  their  work, 
and  for  every  mistake  there  is  a  regular  tariff  of  fines  and 
deductions.  The  constant  strain  to  see  distinctly  results  in  a  whole 
series  of  eye  symptomsl  The  muscular  fatigue  causes  headache, 
which  most  operatives  seem  to  consider  an  inevitable  incident  of 
life.  The  eye,  like  the  hand,  has  its  muscle  cramps  from  over- 
stimulation,  and  its  pareses  from  exhaustion,  but,  while  the  cramp 
of  writers  and  telegraphers  is  regularly  included  in  the  list  of  oc- 
cupational diseases,  nothing  is  said  of  the  far  more  common  ciliary 
spasm  or  the  convergence  insufficiency  of  the  eye  worker.  The 
nervous  exhaustion  which  follows  the  effort  to  stimulate  tired  ocu- 
lar muscles  day  after  day  is  certainly  one  at  least  of  the  causes 
of  lowered  vitality  and  depression.  Neurasthenia  and  the  other 


Occupational  Eye  Diseases  229 

fatigue  and  attention  neuroses  are  said  to  be  practically  universal 
among  the  garment  workers,  and  no  small  part  of  it  can  be  ascribed 
to  eyestrain. 

Miner's  nystagmus  has  always  been  described  as  the  type  of  oc- 
cupational disease  resulting  from  eyestrain  of  a  definite  sort.  Pro- 
gressive myopia  is  no  less  so.  Practically  unknown  in  infancy,  it 
first  appears  occasionally  in  the  early  years  of  school,  and  be- 
comes more  and  more  common  as  the  children  advance  from  grade 
to  grade.  In  the  various  social  classes  it  is  found  to  be  in  direct 
proportion  to  the  amount  of  close  work  which  they  have  to  do. 
Among  the  German  lithographers  Cohn  found  that  45  per  cent 
were  myopic  and  among  the  typesetters  51  per  cent.  The  same 
practical  conclusions  are  true  the  world  over.  The  myopic  eye  is 
a  diseased  eye  and  progressive  myopia  means  a  gradual  failure  of 
vision,  constant  liability  to  ocular  inflammation,  and  in  many  cases 
final  blindness.  It  is  a  true  occupational  disease  which  in  Germany 
accounts  for  approximately  ten  per  cent  of  blindness. 

CONCLUSION 

I  have  given  a  very  brief  resume  of  certain  types  of  disability 
which  may  affect  the  eyes  as  the  result  of  certain  occupations.  Be- 
fore we  can  possibly  have  wise  legislation  we  must  have  far  more 
exact  knowledge  of  many  of  them.  Accidents  and  injuries  are, 
even  to-day,  passably  taken  care  of.  They  are  interesting  to  the 
physician,  and  their  cause,  their  treatment,  and  their  prevention 
are  often  so  obvious  that  much  progress  has  already  been  made 
in  reducing  their  frequency. 

The  study  of  the  trade  poisonings  which  affect  the  eyes  is  still, 
however,  in  its  infancy  in  this  country,  and  is  not  likely  to  progress 
much  till  a  change  is  made  in  the  method  of  investigation.  The 
hospital  physician  is  in  no  position  to  study  them.  They  come  to 
him  as  isolated  cases,  often  in  patients  who  speak  little  or  no  Eng- 
lish and  who  work  at  trades  the  details  of  which  are  unknown  to 
him.  Most  of  them  have  no  pathognomonic  symptoms  to  distin- 
guish them  from  similar  conditions  which  are  not  occupational.  I 
am  sceptical  of  the  scientific  value  of  the  compulsory  reporting  of 
such  cases.  It  will  doubtless  reveal  occasional  extreme  typical 
cases  and  be  worth  while  from  an  educational  standpoint  and  from 
the  standpoint  of  punishing  legal  infractions,  but  that  it  will  add 


230  American  Labor  Legislation  Review 

much  of  scientific  value  to  the  specialist's  knowledge  of  occupa- 
tional diseases  I  doubt.  The  place  to  study  these  conditions  is 
not  in  the  hospital  or  the  clinic  but  in  the  factory.  What  we  need 
is  an  intensive  study,  once  for  all,  of  each  of  the  important  trades 
by  a  group  of  trained  observers. 

Personally  I  believe  that  the  eye  diseases  due  to  fatigue  are  far 
more  important  than  we  commonly  suppose.  More  people  are 
blind  from  malignant  myopia  and  retinal  detachment  than  from  all 
the  trade  poisonings.  More  inefficiency  and  more  misery  are  caused 
by  defective  eyes  than  by  diseased  ones.  There  is  no  field  in  which 
it  would  be  easier  to  enlist  the  enlightened  self-interest  of  employers. 
Any  intelligent  shop  management  must  consider  the  eyes  of  em- 
ployees. There  may  be  a  place  in  our  modern  factory  system  for 
the  lame  and  the  halt,  but  not  for  the  blind  or  the  partly  blind.  Pro- 
fessor Munsterberg  can  tell  by  psychological  tests  whether  it  will 
be  worth  while  to  train  a  girl  as  a  telephone  operator.  The  oculist, 
in  his  turn,  can  not  only  do  a  good  deal  to  convert  unprofitable 
into  profitable  employees ;  he  can  pick  out  employee  after  employee 
whom  no  intelligent  man  could  afford  to  hire.  More  than  this 
he  can  form  a  pretty  good  estimate  of  those  who  are  fit  to-day  but 
will  be  unfit  to-morrow.  There  has  been  so  much  exaggeration 
on  the  subject  of  eyestrain  that  the  medical  profession  has  dis- 
gustedly refused  its  attention,  and  yet  I  know  of  no  one  factor 
that  affects  the  earning  capacity  of  the  laboring  classes  to  such 
an  extent.  I  know  of  no  medical  field  to-day  in  which  the  poor 
and  the  ignorant  have  been  so  entirely  abandoned  to  the  care  of 
the  incompetent  and  the  dishonest.  Here  again  intensive  study 
is  needed. 


INDUSTRIAL  POISONING 


DAVID  L.  EDSALL 
Harvard  Medical  School. 


There  has  been  a  great  deal  said  in  the  past  few  years  about  the 
general  problem  of  industrial  hygiene,  but  until  very  recently  there 
has  been  a  deplorable  lack  in  this  country  of  precise  information  in 
regard  to  industrial  intoxication.  Even  yet,  in  spite  of  the  investiga- 
tions made  by  Dr.  Alice  Hamilton,  Dr.  John  B.  Andrews,  and  others 
for  the  Labor  Bureau,  the  Illinois  Industrial  Disease  Commission, 
and  the  American  Association  for  Labor  Legislation,  we  do  not  have 
anything  like  the  detailed  information  which  is  available  in  Europe. 
I  have  been  able  to  get  more  information  in  two  or  three  days  from 
an  official  introduction  in  a  foreign  country  than  I  can  get  in  this 
country  in  two  or  three  months.  The  only  difficulty  there  is  that 
the  manufacturers  are  often  afraid  you  are  looking  into  trade  se- 
crets ;  they  don't  care  how  much  you  look  into  trade  health. 

Yet  we  know  that  conditions  in  this  country  are  certainly  as  bad 
as  conditions  abroad.  There  used  to  be  claims  that,  owing  to  our 
great  national  ingenuity  and  inventiveness,  or  to  other  causes,  there 
was  not  so  much  industrial  disease  here  and  that,  therefore,  we  did 
not  need  the  rigid  legal  control  which  they  exercise  in  other  coun- 
tries. But  the  recent  investigations  of  phosphorus  and  lead  and 
mercury  poisoning  show  that  we  are  dealing  with  conditions  that 
need  attention  here  just  as  much  as  abroad.  Dr.  Thompson  has 
mentioned  his  experience  in  New  York  with  regard  to  lead  poison- 
ing, and  I  have  had  some  experience  in  Philadelphia.  From  my 
own  records  I  could  produce  more  cases  of  lead  poisoning  from  each 
of  two  white-lead  works  there  than  from  any  similar  works  in  Great 
Britain.  I  have  gone  over  the  records  of  some  of  the  latter  and 
know  what  they  are. 

The  work  I  have  done,  however,  has  been  purely  individual. 
Official  information  and  investigation  is  much  better.  The  expe- 
rience we  gain  from  unofficial  investigations  is  very  vague  and  frag- 
mentary and  brings  to  light  only  a  fraction  of  what  exists.  As  good 


232  American  Labor  Legislation  Review 

evidence  as  I  have  ever  had  of  this  fact  was  in  connection  with  two 
large  plants,  both  of  which  used  carbon  bisulfid  and  lead.  One  manu- 
facturer told  me  they  had  so  little  trouble  they  did  not  pay  any 
attention  to  it  at  all.  The  other  plant,  carrying  on  the  same  processes, 
told  me  with  the  greatest  openness  that  they  had  considerable 
trouble  with  carbon  bisulfid  and  lead  in  spite  of  great  precautions. 
It  is  essential  to  get  precise  and  definite  studies  on  the  subject  from 
an  official  standpoint. 

.  Such  studies  are  particularly  necessary,  I  believe,  by  reason  of 
the  fact  that  a  great  many  processes  in  this  country  differ  from  the 
processes  abroad.  It  is  an  interesting  fact  that  Great  Britain  has 
had  a  different  problem  to  deal  with  from  that  in  Germany.  As 
we  know,  Germany's  vast  commercial  importance  is  the  development 
of  the  last  half  century  or  less  and  it  has  been  possible,  therefore,  to 
put  into  effect  there  almost  any  law  affecting  the  health  of  employees 
without  greatly  disturbing  the  manufacturer.  In  England  many  per- 
sons carried  on  trades  in  very  old  localities  and  old  shops  and  if  they 
had  enacted  drastic  laws  immediately  they  would  have  destroyed 
their  industries.  They  had  different  conditions.  We  are  only  mak- 
ing a  beginning  at  regulation  and  are  far  behind  both  Germany  and 
Great  Britain.  But  we  must  know  our  own  conditions,  and  not  go 
too  much  on  observations  in  other  countries,  if  we  are  going  to  deal 
justly  with  our  industries.  From  the  United  States  Bureau  of  Labor 
and  other  such  sources  we  must  get  the  information  we  need.  No 
one  need  feel,  because  we  have  acquired  some  valuable  knowledge  of 
conditions  in  the  last  two  or  three  years,  that  we  have  approached  a 
fraction  of  what  is  really  important. 

In  getting  this  information  and  in  drawing  up  regulations  based 
upon  it,  the  first  thing  we  need  is  uniformity, — uniformity  between 
investigating  agencies  and  between  states.  If  we  cannot  have  uni- 
formity in  the  first  place  we  will  have  trouble  in  classification.  More- 
over, it  is  extremely  important  in  legislation,  for  any  regulation 
of  these  things  in  one  state,  when  there  is  no  regulation  in  surround- 
ing states,  may  do  such  harm  to  industries  that  they  will  move  to  an- 
other state  or  new  industries  will  not  develop  there.  Uniformity 
is  the  first  step  in  regulation. 

The  reporting  of  industrial  diseases,  and  the  reporting  of  a  larger 
number  than  now  required  in  the  eight  states  that  demand  such 
reports,  furnishes  the  most  important  source  of  information,  The. 


Industrial  Poisoning  233 

importance  of  this  is  at  once  recognizable  by  anyone  who  knows  even 
vaguely  the  effect  of  the  reporting  of  infectious  diseases,  though  very 
few  except  those  interested  know  the  profound  effect  of  the  report- 
ing of  industrial  diseases.  As  a  striking  example  of  this,  I  was  talk- 
ing with  Dr.  Legge,  the  head  of  the  medical  inspection  of  factories 
in  England,  in  regard  to  their  regulations  concerning  industrial  in- 
toxication. His  long  experience  under  the  British  reporting  law 
has  made  him  familiar  with  almost  all  the  plants  in  Great  Britain, 
and  particularly  with  all  the  different  operations  of  these  plants. 
He  told  me,  if  I  wanted  to  see  a  curious  difficulty  which  they  had 
not  been  able  to  remedy,  to  go  to  a  certain  pottery.  Then  he  pointed 
out  various  plants  elsewhere  that  exhibited  simple  or  more  complex 
means  of  overcoming  particular  dangers.  This  detailed  information 
gave  him  precise  knowledge  as  to  where  any  company  needed 
to  be  corrected  and  where  they  did  not  need  to  be  corrected.  There 
is  other  important  information  that  cannot  be  gained  in  any  way 
except  by  the  reporting  of  diseases.  In  particular  it  gives  a  definite 
idea  as  to  whether  or  not  regulations  are  doing  the  right  amount  of 
good. 

Another  fact  that  the  reporting  of  industrial  diseases  opens  out  is 
the  occasional  necessity  for  rather  drastic  special  regulations  in  re- 
gard to  matters  of  this  kind,  such  as  the  French  laws  concerning 
the  use  of  lead  paint.  In  England  they  have  had  little  improvement, 
owing  to  their  regulations,  in  lead  poisoning  among  painters.  It 
may  be  that  they  will  be  forced  into  drastic  prohibitory  laws  like 
those  in  France. 

The  medical  inspection  of  working  people  exposed  to  conditions 
of  this  kind  will  unquestionably,  I  am  sure,  lead  to  improvements 
of  conditions  equal  to  those  from  reporting  diseases.  The  manufac- 
turers abroad  that  I  have  talked  with  about  this,  and  I  talked  with 
a  number  in  England,  were  actually  enthusiastic  then,  though  they 
opposed  it  at  first.  Some  told  me  that,  although  required  by  law  to 
have  an  inspection  once  a  month,  they  had  voluntarily  introduced 
it  once  a  week  because  it  had  the  value  of  detecting  any  trouble  at 
once.  The  manufacturer  has  been  rather  condemned  this  morning  by 
one  or  two  speakers.  My  experience  has  been  that  very  frequently 
he  is  quite  as  willing  to  cooperate  as  anyone  else.  Manufacturers 
may  be  divided  into  three  classes :  those  who  are  educated  as  to  the 
value  of  these  matters,  those  who  are  willing  to  be  educated,  and 


234  American  Labor  Legislation  Review 

those  who  are  uneducated  and  unwilling.  But  many  of  them  are 
willing  to  do  what  they  can  if  the  matter  is  once  made  clear  to  them. 

An  essential  thing  that,  it  seems  to  me,  needs  to  be  done  in  over- 
coming the  conditions  we  are  facing  is  to  establish  some  definite 
standards.  That  is  true  of  anything  relating  to  industrial  condi- 
tions or  anything  else.  You  cannot  make  improvements  unless  you 
know  the  standard  of  improvements.  Most  of  our  laws  in  regard 
to  industrial  hygiene  throw  the  whole  burden  on  the  medical 
inspector.  If  he  is  an  honest  and  capable  man  he  may  do  it  well. 
If  he  tends  to  be  a  grafter,  he  can  use  his  position  for  that  purpose. 
If  he  is  uninstructed  he  does  nothing.  In  England  the  regulations 
in  regard  to  potteries  fill  a  large  pamphlet,  going  precisely  into  every 
detail.  This  is  fair  to  the  manufacturer,  because  he  knows  what  he 
must  do ;  but  it  holds  him  up  if  he  does  not  do  it.  Standards  should 
be  given  in  every  instance  when  possible,  so  that  the  manufacturer 
may  come  up  to  the  standard  and  not  just  vaguely  try  to  do  the 
right  thing.  Even  then  inspectors  should  be  trained. 

Another  important  thing  is  that  the  regulations  shall  not  be  de- 
pendent upon  the  occasional  meeting  of  a  state  legislature,  that  there 
shall  be  some  provision  similar  to  that  in  the  English  law,  which 
practically  gives  the  Secretary  of  State  power  to  modify  these  regu- 
lations as  may  seem  to  him  wise  if  he  submits  the  changes  to  the 
action  of  Parliament  as  soon  as  possible;  but  in  the  meantime  he  can 
protect  working  people  from  changes  in  processes,  or  other  things 
that  might  be  dangerous,  and  not  wait  for  indefinite  periods. 

There  is  only  one  thing  more  I  should  like  to  say,  and  that  is  that 
I  think  we  have  been  and  still  are  altogether  too  prone  to  consider 
occupational  poisoning  of  various  kinds  merely  as  showing  certain 
picturesque  results.  We  tend  to  look  on  colic,  palsy,  and  encephalo- 
pathy,  for  example,  as  being  all  of  the  important  effects  of  lead 
poisoning,  but  the  main  effects  of  lead  poisoning  are  other  things; 
much  more  ill  health  is  caused  by  the  general  effects  on  the  health, 
the  arteries,  the  kidneys,  and  digestion.  I  think  we  have  no  more 
right  to  speak  of  lead  colic  and  such  things  as  the  main  effects  of 
lead  poisoning  than  we  have  to  speak  of  drowsiness  as  the  main 
effect  of  the  morphine  habit.  Any  statistics  that  we  can  get  only 
show  a  minor  fraction  of  the  results  of  these  intoxications.  They 
undoubtedly  cause  many  times  the  bad  results  that  appear  from 
these  definite,  discoverable  consequences. 


COOPERATION  IN  PROMOTING  INDUSTRIAL  HYGIENE 


HENRY  R.  SEAGER 
President,  American  Association  for  Labor  Legislation. 


Nothing  could  better  illustrate  the  advantages  of  cooperation  in 
our  efforts  to  promote  industrial  ^hygiene  than  the  papers  that  have 
been  presented  at  this  Conference,  or  indeed  than  this  Conference 
itself.  The  greatest  present  need  in  this  field  in  the  United  States 
is  undoubtedly  fuller  knowledge.  We  need  to  know  more  accurately 
*  what  are  the  occupational  diseases  to  which  American  wage-earners 
are  exposed.  We  need  to  know  the  conditions  which  give  rise  to 
these  diseases  in  the  occupations  in  which  they  are  found.  Finally, 
we  need  to  know  the  easiest  and  most  effective  means  of  changing 
conditions  so  that  these  diseases  may  be  prevented.  The  fact  that 
this  is  only  the  Second  National  Conference  on  Industrial  Diseases 
is  evidence  of  the  tardy  attention  we  are  giving  to  occupational  dis- 
eases in  this  country.  For  some  time  to  come  careful,  intensive 
studies,  like  that  described  by  Mr.  Hoffman,  must  precede  the  intro- 
duction of  remedial  measures.1 

If  fuller  knowledge  is  what  we  most  need,  the  group  to  which 
we  must  look  for  light  is  obviously  that  of  the  trained  physicians 
who  have  taken  to  heart  the  old  adage  that  an  ounce  of  prevention 
is  worth  a  pound  of  cure,  and  who  are  deliberately  turning  aside 
from  the  work  of  curing  the  sick  to  the  more  important,  if  less 
appreciated,  work  of  searching  out  the  causes  of  sickness  and 
devising  measures  that  will  narrow  the  field  over  which  these  causes 
operate.  But  in  connection  with  occupational  diseases  physicians 
require,  perhaps  more  than  in  any  other  department  of  preventive 
medicine,  the  cooperation  of  other  groups.  This  is  because  occu- 
pational diseases  must  be  studied  not  merely  in  the  symptoms  of 

1  The  results  of  one  such  study  have  been  published  in  a  monograph  by  Mrs. 
Lindon  Bates  on  Mercury  Poisoning  in  the  Industries  of  New  York  City  and 
Vicinity,  by  the  Women's  Welfare  Department  of  the  National  Civic  Feder- 
ation. Copies  may  be  secured  by  application  to  the  American  Association  for 
Labor  Legislation,  Metropolitan  Tower,  New  York  City. 


236  American  Labor  Legislation  Review 

their  victims,  but  in  direct  connection  with  the  occupations  that 
give  rise  to  them.  It  is  not  enough  that  employees  who  have  con- 
tracted occupational  diseases  submit  themselves  to  examination  and 
treatment;  other  employees  in  the  same  trades  who  have  not  yet 
contracted  the  diseases  must  be  examined,  and  all  must  be  induced 
to  furnish  full  information,  not  only  in  regard  to  the  places  and 
conditions  under  which  they  work,  but  also  in  regard  to  their 
homes  and  habits  of  life.  It  is  not  enough  for  employers  to  send 
employees  who  require  treatment  to  company  physicians ;  they  must 
also  grant  free  access  to  their  plants  and  permit  periodical  phy- 
sical examinations  to  be  made  of  all  their  employees,  both  well  and 
ill.  Finally,  to  bring  physicians,  employees,  and  employers  together 
in  a  united  effort  to  lessen  the  ravages  of  occupational  diseases, 
the  zeal  and  enthusiasm  of  social  workers  are  required.  As  in  the 
case  of  tuberculosis,  itself  to  some  extent  an  occupational  disease, 
so  for  occupational  diseases  generally,  the  road  to  reform  lies 
through  a  vigorous  campaign  of  public  education.  Social  workers 
must  be  counted  upon  to  organize  this  campaign  and  to  press  it 
on  to  a  successful  issue. 

A  comparison  of  conditions  in  the  United  States  with  conditions 
in  Germany  and  in  the  United  Kingdom  indicates  how  far  we  are 
behind  those  countries  from  the  point  of  view  of  public  appreciation 
of  the  importance  of  industrial  hygiene.  In  introducing  the  sys- 
tem of  obligatory  illness  insurance  for  wage-earners  in  1883  an<^ 
requiring  employers  to  contribute  one-third  of  the  necessary  prem- 
iums, Germany  made  industrial  hygiene  thenceforth  a  matter  of 
supreme  concern  to  her  industrial  classes.  Preventing  occupational 
diseases  was  changed  from  the  interest  of  a  few  unusually  humane 
or  unusually  far-sighted  employers  to  a  pursuit  in  which  the  most 
mercenary  and  penny-wise  were  almost  equally  zealous.  Reducing 
the  number  of  employees  to  fall  ill  and  the  number  of  days  of 
illness  for  those  who  could  not  be  kept  well,  now  meant  reducing 
sick-insurance  premiums  and  thus  adding  directly  to  the  year's 
profits.  Whatever  may  be  thought  of  incidental  effects  of  the 
compulsory  insurance  system,  there  can  be  no  doubt  that  the  won- 
derful progress  that  Germany  has  made  in  the  last  thirty  years  in 
the  field  of  preventive  medicine  has  been  largely  due  to  this  bold 
policy  of  the  Iron  Chancellor. 

The  United  Kingdom,  in  adding  in  10,06  to  industrial  accidents 


Cooperation  in  Promoting  Industrial  Hygiene  237 

certain  specified  industrial  diseases  as  grounds  on  which  wage- 
earners  suffering  a  loss  of  earning  power  might  demand  compen- 
sation from  their  employers,  went  even  further  than  Germany. 
Under  this  plan  the  employer  had  to  pay,  not  merely  one-third  of 
the  premiums  out  of  which  indemnities  should  go  to  wage-earners, 
but  the  whole  indemnity  prescribed  by  the  law.  The  list  of  occu- 
pational diseases  has  been  steadily  expanded  since  the  law  was  first 
passed,  until  now  more  than  a  score  are  included;  and  as  regards 
these  diseases,  it  will  readily  be  believed,  the  British  employer  has 
become  the  eager  coworker  with  the  sanitarian  in  trying  to  lessen 
in  every  possible  way  the  risk  to  which  his  employees  are  exposed. 
The  National  Illness  and  Unemployment  Insurance  Law,  which 
comes  into  operation  next  month,  gives  the  British  employer  an 
interest  equal  to  that  of  his  German  colleague  in  reducing  all 
forms  of  illness.  It  is  no  doubt  unfair,  as  well  as  unkind,  to 
British  physicians  to  ascribe  their  opposition  to  certain  features  of 
this  law  to  a  fear  that  it  will  put  them  out  of  business;  but  it  is 
certain  that  in  England,  as  in  Germany,  the  new  policy  will  give 
a  tremendous  impetus  to  preventive  medicine. 

In  the  United  States  illness  insurance,  even  through  sick-benefit 
societies,  is  as  yet  little  developed.  Even  without  it,  it  is  probably 
true  that  on  strict  financial  grounds  it  is  worth  while  for  the 
American  employer  to  give  greater  attention  than  is  customary 
to  keeping  his  employees  well  and  strong;  but  for  employers  in  our 
big  cities,  with  large  reserve  forces  of  labor  to  draw  on,  the 
proposition  is  debatable.  It  is,  therefore,  essential  that  social  work- 
ers cooperate  with  physicians  in  trying  to  induce  employers,  on 
grounds  of  humanity,  or  self-interest,  or  both,  to  do  their  indis- 
pensable part  in  furthering  the  cause  of  industrial  hygiene.  Social 
workers  must  also  rouse  employees  to  an  appreciation  of  the  risks 
they  run  in  unhealthful  occupations  and  induce  them,  not  only  to 
demand  safer  conditions,  but  to  give  the  attention  to  personal 
hygiene  that  is  now  so  commonly  lacking. 

In  preference  to  elaborating  further  on  the  subject  in  general 
terms,  I  prefer  to  illustrate  the  need  of  cooperation  in  promoting 
industrial  hygiene  by  describing  some  of  the  work  in  which  the 
American  Association  for  Labor  Legislation  has  been  concerned 
since  its  organization  six  years  ago.  Its  founders  early  recognized 
that  industrial  hygiene  was  one  of  our  great  national  needs.  How 


238  American  Labor  Legislation  Review 

to  impress  this  view  on  a  busy  and  indifferent  public  was  the  prob- 
lem. It  happened  that  the  European  sections  of  the  Association 
had  recently  been  giving  much  attention  to  the  prohibition  of  the 
use  of  poisonous  phosphorus  in  the  manufacture  of  matches,  and 
that  European  governments  had  even  made  treaties  for  their  mutual 
protection  on  this  subject.  Poisonous  phosphorus  thus  seemed 
a  promising  industrial  poison  with  which  to  begin  our  campaign. 

When  Dr.  Andrews,  the  secretary  of  the  Association,  began  his 
investigation  of  the  match  industry  for  the  federal  Bureau  of 
Labor,  phosphorus  necrosis,  "phossy-jaw",  was  a  disease  of  which 
it  is  safe  to  say  few  laymen  in  the  United  States  outside  of  match 
factories  had  ever  heard,  and  which  few  physicians  had  ever  had 
occasion  to  diagnose.  His  first  task  was  to  satisfy  himself  that  this 
disease  was  one  of  the  necessary  by-products  of  the  manufacture 
of  poisonous  matches  in  the  United  States,  as  it  was  acknowledged 
to  be  in  Europe ;  his  second,  to  convince  an  influential  body  of  pub- 
lic opinion  that  such  a  dangerous,  loathsome,  and  unnecessary  dis- 
ease ought  to  be  stamped  out  here  by  prohibitive  legislation,  as  it 
had  been  stamped  out  by  the  other  civilized  nations  of  the  world. 
Without  the  cooperation  of  employers,  employees,  and  physicians, 
his  investigation  must  have  proved  a  failure.  I  need  not  now  detail 
the  steps  by  which  it  was  made  a  success,  nor  the  two  years*  cam- 
paign waged  by  the  American  Association  for  Labor  Legislation 
which  culminated  last  April  in  the  enactment  of  the  Hughes-Esch 
Law  imposing  a  prohibitive  tax  on  poisonous  phosphorus  matches 
manufactured  in  the  United  States  after  July  i,  1913.  Suffice  to  say 
that  but  for  the  cooperation  of  the  majority  of  the  match  manu- 
facturers in  agreeing  not  to  oppose  the  bill,  on  condition  that  it 
should  apply  to  all  of  them  alike  and  that  it  should  include  the 
prohibition  of  the  importation  of  poisonous  phosphorus  matches, 
the  act  probably  would  not  have  been  passed.  Further,  but  for  the 
cooperation  of  physicians  and  hospital  authorities  in  supplying  evi- 
dence of  cases  of  phosphorus  necrosis  and  of  the  ineffectiveness  of 
preventive  measures  falling  short  of  outright  prohibition,  the  public 
could  not  have  been  aroused  as  it  was  against  this  evil.  Finally, 
but  for  the  aid  of  match  workers,  one  of  whom  went  to  Washing- 
ton to  display  his  cruelly  disfigured  face  to  the  members  of  the  Ways 
and  Means  Committee  for  the  sake  of  his  fellow  workers  exposed 
to  a  similar  fate,  those  gentlemen  would  not  have  reported  out  the 
bill,  which  had  so  long  been  held  in  committee. 


Cooperation  in  Promoting  Industrial  Hygiene  239 

The  issue  presented  by  the  use  of  poisonous  phosphorus  in  the 
American  match  industry  was  simpler  and  more  clear-cut  than  that 
found  in  connection  with  any  other  industrial  poison.  Usually  pre- 
ventive measures,  not  outright  prohibition,  are  the  remedies  to  be 
sought,  and  usually  there  is  great  difference  of  opinion  as  to  what 
preventive  measures  are  best  and  how  they  may  best  be  made 
effective. 

Appreciating  the  need  of  further  information  about  occupational 
diseases,  the  Association  has  been  responsible  for  the  introduction 
and  enactment  by  eight  states  in  the  last  two  years  of  bills  requiring 
physicians  to  report  certain  specified  industrial  diseases  to  desig- 
nated state  authorities,  usually  the  state  commissioner  of  labor. 
Legislatures  are  only  too  ready  to  pass  bills  imposing  duties  upon 
physicians !  It  was  another  matter  to  devise  machinery  to  insure  that 
reports  of  value  would  be  sent  in  and  that  the  statistics  so  secured 
would  be  turned  to  useful  account. 

Partly  for  this  purpose  and  partly  to  promote  industrial  hygiene 
in  other  ways,  the  New  York  Association  for  Labor  Legislation, 
on  the  initiative  of  its  secretary,  Mr.  Paul  Kennaday,  organized  last 
October,  in  conjunction  with  the  New  York  Academly  of  Medicine, 
a  joint  committee  on  industrial  diseases.  Dr.  W.  Oilman  Thomp- 
son has  been  from  the  first  the  guiding  spirit  of  this  committee,  and 
its  frequent  evening  meetings  at  his  house  have  already  resulted  in 
achievements  which  promise  much  for  its  future  usefulness.  It 
was  felt  by  all  that  the  first  work  of  the  committee  should  be  to 
try  to  make  the  law  requiring  the  reporting  of  industrial  diseases 
more  effective.  Dr.  Hatch,  statistician  of  the  department  of  labor, 
was  asked  to  be  a  member  of  the  committee.  He  gladly  accepted 
the  offer  of  the  committee  to  cooperate  with  him  in  drawing  up  a 
more  satisfactory  form  for  the  reporting  of  occupational  diseases 
than  the  department  had  been  using.  A  much  improved  reporting 
blank  was  finally  agreed  upon,  and  this  blank  is  now  not  only  in 
use  in  New  York,  but  is  likely  to  be  adopted  by  other  states  which 
require  occupational  disease  reports.  To  impress  upon  physicians 
the  importance  of  cooperating  with  the  state  authorities  in  the 
efforts  to  collect  adequate  statistics  of  occupational  diseases,  the 
committee  next  undertook  the  compilation  of  a  pamphlet  on  the 
nomenclature  of  occupational  diseases,  which  is  to  be  printed  and 
circulated  by  the  department  of  labor  to  all  of  the  physicians  in 
the  state. 


240  American  Labor  Legislation  Review 

The  services  of  Dr.  E.  E.  Pratt  were  then  secured  to  make  a  re- 
port on  all  the  investigations  of  occupational  diseases  that  had  up 
to  that  time  been  undertaken  in  New  York  State.  With  this  report 
as  a  guide,  the  committee  advised  the  special  Factory  Investigating 
Commission  of  this  state  as  to  the  occupational  diseases  most  likely 
to  repay  further  investigation.  The  other  work  undertaken  by 
the  commission  is  so  broad  that  the  attention  it  can  devote  to  occu- 
pational diseases  has  proved  to  be  disappointingly  slight,  but  it  has 
asked  the  cooperation  of  the  committee  in  framing  recommendations 
to  the  state  legislature  for  the  creation  of  a  permanent  bureau  for 
the  study  of  occupational  diseases,  and  with  the  constantly  growing 
interest  in  the  subject  there  is  strong  likelihood  that  such  a  recom- 
mendation will  be  acted  upon  favorably. 

Besides  these  more  important  activities,  the  committee  has  served 
as  a  clearing-house  of  information  for  numerous  other  groups  in- 
terested from  other  points  of  view  in  the  general  subject  of  in- 
dustrial hygiene.  For  example,  it  has  met  with  the  committee  on  in- 
dustrial poisons  of  the  Chemists'  Club  of  New  York  City  and  dis- 
cussed possible  lines  of  cooperation  during  the  coming  winter.  It  is 
the  purpose  of  this  committee,  so  soon  as  the  necessary  funds  are  se- 
cured, to  prosecute  investigations  of  the  numerous  occupational  dis- 
eases that  have  not  thus  far  received  adequate  attention.  Its  mem- 
bers, through  articles  and  addresses  to  all  sorts  of  audiences,  are 
constantly  urging  the  importance  of  greater  attention  to  industrial 
hygiene.  Also  through  its  members  it  hopes  to  induce  some  em- 
ployers voluntarily  to  introduce  the  precautionary  measures  that 
its  investigations  and  the  investigations  of  others  prove  to  be  de- 
sirable. So  soon  as  the  practicability  and  efficacy  of  these  measures 
shall  have  been  demonstrated,  the  Association  for  Labor  Legislation 
will  seek  to  have  their  introduction  made  mandatory  through  labor 
laws,  so  that  the  lives  and  health  of  all  employees  may  be  protected. 

Our  experience  in  New  York  has  convinced  us  that  the  organiza- 
tion of  a  committee  of  physicians,  sanitarians,  and  interested  lay- 
men, such  as  I  have  described,  is  an  important,  if  not  a  necessary,  aid 
to  effective  work  for  industrial  hygiene.  Physicians  and  sanitari- 
ans must  supply  the  expert  knowledge,  but  for  the  most  part  they  are 
too  busy  to  direct  the  work  of  educating  public  opinion  or  of  shaping 
the  legislation  which  this  knowledge  proves  to  be  necessary.  This 


Cooperation  in  Promoting  Industrial  Hygiene  241 

part  of  the  task  must  devolve  mainly  on  social  workers.  In  addition, 
industrial  chemists,  representatives  of  life  insurance  companies,  and 
officials  of  the  appropriate  departments  of  the  city  and  state  govern- 
ments, may  be  drawn  in  to  form  a  group  which  is  representative  of 
enlightened  and  progressive  public  opinion  touching  this  problem. 
Through  such  a  group  tasks  can  easily  be  accomplished  that  would 
be  impossible  for  men  working  in  isolation,  or  even  for  the  associated 
miembers  of  any  single  profession. 

We  recommend  the  organization  of  similar  committees  in  other 
states  as  an  efficient  means  of  advancing  the  cause  which  we  all 
have  at  heart. 


GENERAL  DISCUSSION 

DR.  WARREN  COLEMAN,  Bellevue  Hospital,  New  York  City:  In 
view  of  the  importance  of  the  subject  of  industrial  diseases,  may  I 
be  permitted  to  suggest  that  a  petition  be  presented  from  this  section 
to  the  House  of  Delegates  of  the  American  Medical  Association  re- 
questing the  appointment  of  a  committee  to  cooperate  with  the 
American  Association  for  Labor  Legislation  to  promote  the  study  of 
industrial  diseases. 

This  motion  was  duly  seconded  and  unanimously  carried. 

DR.  ROSALIE  SLAUGHTER  MORTON,  New  York  City:  I  have  been 
especially  interested  in  this  joint  session.  It  seems  a  great  evidence 
of  progress  that  the  laity  and  the  profession  of  medicine  should  get 
together  to  work  for  the  public  good.  The  work  done  by  the  Asso- 
ciation for  Labor  Legislation  has  gone  so  far  that  I,  as  vice-president 
of  the  Medical  Section,  feel  it  an  honor  to  cooperate  with  you. 

DR.  C.  F.  STOKES,  Surgeon  General,  United  States  Navy,  Wash- 
ington, D.  C.:  We  have  been  looking  after  occupational  diseases  in 
the  Navy,  but  entirely  on  the  basis  of  military  efficiency.  There  is 
no  humanitarian  factor  in  it.  Sanitation  generally  has  reached  a 
satisfactory  condition.  But  in  a  battleship  we  find  grouped  together 
a  more  varied  set  of  activities  than  will  be  found  elsewhere  in  the 
same  space. 

Respecting  the  eye  troubles,  the  men  who  adjust  arc-lights  have 
severe  troubles  caused  by  the  sudden  glare.  In  our  turrets,  too, 
we  have  our  gun  pointer,  the  man  who  points  the  guns;  the  range 
is  so  long  that  he  must  use  a  telescope,  and  we  have  found  that  these 
men,  who  started  in  with  normal  vision,  have  dropped  down  to  eight 
and  ten  below.  That  is  something  which  is  very  important  to  the 
Navy. 

Then  there  are  the  toxic  gases.  We  find  in  almost  all  these  great 
ships  a  type  of  gas  which  has  caused  death  in  many  instances,  hap- 
pily in  foreign  navies.  The  element  at  work  seems  to  be  a  diminu- 
tion of  oxygen.  After  two  or  three  rounds  at  battle  practice,  the 
carbon  dioxid  runs  up  to  forty.  We  have  powder  gas  at  work  there 
which  gives  us  a  carbon  monoxid  poison.  Men  who  have  at  the 


General  Discussion  243 

beginning  of  firing  a  pulse  rate  of  seventy-two,  have  at  the  end  of 
ten  minutes  a  pulse  rate  of  one  hundred  and  twenty.  And  in  the  fire 
rooms  the  heat  prostrations  are  due  largely  to  gas  contamination, 
carbon  monoxid.  The  same  thing  applies  to  submarines.  We  have 
been  working  at  this  gas  problem. 

I  was  interested  in  what  Dr.  Dana  had  to  say.  It  is  now  known 
that  there  were  some  two  thousand  men  at  Port  Arthur  during  the 
Russian-Japanese  War  who  were  invalided  home  by  reason  of  insan- 
ity. In  other  words,  they  were  not  temperamentally  fit  for  that 
hazardous  work.  We  find  that  some  men  get  along  very  well  during 
peace  times  but,  when  it  comes  to  battle  practice,  or  possibly  to 
some  great  hazard,  they  break  down.  They  are  temperamentally 
unfit.  These  are  all  military  considerations  bearing  on  occupational 
hygiene. 

DR.  MARK  D.  STEVENSON,  Akron,  Ohio:  Occupational  eye  dis- 
eases may  be  caused  by  exposure  to  excessive  light  or  heat,  to  poison- 
ous gases  or  fumes,  and  by  prolonged  and  peculiar  strain. 

First  are  diseases  due  to  excessive  light  or  heat,  e.  g.,  in  electric 
welders,  steel  smelters,  and  in  those  who  melt  or  anneal  glass.  Metal 
polishers  and  buffers,  brightening  surfaces  which  they  must  closely 
watch,  often  suffer  with  hyperesthesia  of  the  retina.  This  can  be 
relieved  by  proper  lenses  or  colored  glasses.  Excessive  heat  and 
light  are  met  with  in  iron  and  steel  works.  Men  can  watch  a  fur- 
nace until  the  temperature  is  up  to  2000°  F.,  but  before  it  gets  to 
3000°  colored  glasses  should  be  worn.  If  some  of  these  hot  furnaces 
are  looked  into  without  lenses  it  is  several  minutes  before  the  eye  can 
see  ordinary  objects  again.  Some  men  seem  to  have  surprising 
immunity  from  bad  results  in  dealing  with  these  white-hot  furnaces ; 
others  cannot  endure  them  and  must  change  their  work.  Herbert 
Parsons  and  Marcus  Gunn,  who  visited  some  of  the  important 
glass  works  in  England  in  1908  to  gather  statistics  of  industrial 
diseases  for  the  framing  of  the  Workmen's  Compensation  Act,  state 
that  bottle  workers  have  a  characteristic  form  of  cataract, — typi- 
cally, a  dense,  well-defined  disk  of  opacity  in  the  center  of  the  poste- 
rior cortex.  Excessive  heat  and  bright  light  are  said  to  be  the  causes, 
but  the  Germans  claim  that  heat  is  the  most  important  cause.  Weyl 
mentions,  besides  glass-blowers,  fire  workers,  puddlers,  blacksmiths, 
bakers,  and  cooks.  Great  care  is  required  to  avoid  very  strong  light 


244  American  Labor  Legislation  Review 

flashes  before  the  eyes,  as  in  short  circuits  and  electric  welding.  In 
the  latter  large  shields  are  worn,  in  the  center  of  which  are  four  al- 
ternate layers  of  blue  and  red  glass.  Helmets  and  screens,  with  four 
or  six  layers  of  red  and  green  glass,  are  often  used.  The  tempera- 
ture in  electric  welding  goes  as  high  as  7000°  F.,  but  the  question 
of  whether  it  is  the  heat  or  the  chemical  rays  that  act  so  harm- 
fully has  not  been  settled.  If  the  eyes  catch  the  light  they  are  affected 
at  once,  but  usually  the  effect  appears  some  hours  afterwards.  The 
eyes  feel  swollen  as  if  filled  with  burning  sand  and  the  pain  is 
usually  severe;  the  lids  are  swollen  and  there  is  much  lacrimation. 

Other  diseases  are  due  to  working  in  certain  poisonous  gases, 
fumes,  dusts,  or  substances,  such  as  bisulfids  of  carbon,  lead,  etc. 
Dinitrobenzol  is  largely  employed  in  making  explosives.  During 
the  various  processes  of  its  manufacture  fumes  are  given  off  which 
affect  vision.  These  can  be  lessened  by  properly  covering  the  mix-' 
tures  and  by  the  use  of  fans  and  exhaust  apparatus.  Respira- 
tors and  glasses  should  be  used.  Bisulfid  of  carbon,  formerly  much 
used  in  vulcanizing  rubber,  caused  impaired  eyesight,  but  this  pro- 
cess has  been  so  greatly  modified  that  it  is  now  of  little  impor- 
tance in  causing  ocular  lesions.  Toxic  amblyopias,  due  to  tobacco, 
ethyl  alcohol  and  wood-alcohol,  are  too  well  known  to  require 
consideration.  The  eye  affections  formerly  attending  the  manu- 
facture of  iodoform  have  by  care  been  eliminated.  A  few  cases  of 
eye  involvement  have  been  reported  in  dye  factories  from  handling 
the  various  coal-tar  preparations.  Arsenic  and  paris  green  from 
wall-paper,  artificial  flowers,  paper  hangings  and  paintings,  have 
caused  various  visual  disturbances.  Painters,  plumbers,  electro- 
typers,  file-cutters  and  many  others,  through  handling  lead,  are  like- 
ly to  get  chronic  lead  poisoning,  causing  central  and  peripheral 
affections  of  sight,  various  paralyses,  retrobulbar  neuritis,  etc. 
Poisonous  gases  and  fumes  are  also  formed  in  certain  lead  processes, 
and  in  shoe  cement,  japanned  or  patent  leather,  and  rubber  manu- 
facturing, where  the  mixtures  containing  naphtha  are  sometimes  al- 
lowed to  remain  in  uncovered  containers  and  proper  ventilation 
is  not  insisted  upon. 

Eye  diseases  may  also  be  due  to  occupations  requiring  prolonged 
and  peculiar  use  of  the  eyes,  e.  g.,  nystagmus  in  miners,  which  is 
due  to  their  peculiar  way  of  looking  at  their  work.  Treatment 
consists  in  changing  the  kind  of  work.  After  relief  the  miner  can 


General  Discussion 


245 


return  to  his  work  if  the  head  can  be  kept  straight  and  the  eyes  are 
not  often  turned  upward.  Snell  mentions  several  other  occupations 
which  he  has  thought  might  cause  nystagmus,  because  the  eyes  were 
turned  directly  or  obliquely  upward. 

DR.  WALTER  F.  BUTTON,  Carnegie,  Pa.:  The  occupational  dis- 
ease which  results  from  the  manufacture  of  vanadium  is  not  as  yet 
well  known.  There  are  two  reduction  plants  in  the  United  States,  in 
which  there  are  a  number  of  employees.  The  products  are  being 
used  more  and  more  in  the  manufacture  of  steel,  in  photography, 
and  in  manufacturing  plants  where  mordants  are  used.  The  mon- 
oxid  is  used  in  photography ;  the  dioxid  in  printing  calicoes,  and  the 
trioxids  in  the  manufacture  of  steel.  This  disease  will  become 
more  and  more  well  known  as  the  use  of  vanadium  products  in- 
creases. I  should  like  to  call  your  attention  to  an  article  in  the 
Journal  of  the  American  Medical  Association  of  June  3,  1911. 

MR.  E.  C.  CURTIS,  New  York  City:  Speaking  for  the  men  who 
work  in  compressed  air,  I  think  we  need  very  much  the  cooperation 
of  physicians  and  of  the  American  Association  for  Labor  Legislation 
to  better  our  condition.  Up  to  the  present  time  the  doctors  have  not 
attended  to  this  industry  as  they  should.  There  were  3692  cases  of 
compressed-air  illness  in  one  small  job,  the  East  River  Tunnel.  I 
have  known  personally  of  men  who  have  entered  these  air-locks 
without  the  doctor  ever  looking  at  them ;  there  were  small  boys  who 
acted  as  doctors  and  passed  the  men  to  go  into  the  caissons.  We 
had  one  case  in  particular  where  we  ought  to  get  a  conviction ;  we 
went  before  the  doctor  proving  that  the  man  was  sent  down  with 
an  abscess  on  his  neck,  and  was  dead  before  he  got  half  way  down. 
That  is  one  of  the  conditions  under  which  the  men  I  represent  are 
compelled  to  suffer,  and  I  claim  there  is  carelessness  among  the  doc- 
tors. We  had  another  case  only  recently,  where  a  man  was  put  into 
the  medical  air-lock  while  a  new  invention  was  being  tried  on  him. 
They  put  him  into  cold  air.  The  man  was  frozen  to  death  in  the 
medical  air,  taken  out  of  there  and  laid  for  three  solid  hours  on  a 
plank,  and  then  brought  home  dead.  The  physicians  do  not  seem  to 
value  human  life  at  all.  Here  was  a  man  with  six  children  brought 
home  dead  for  experimental  purposes.  But  if  the  physicians  are 
going  to  be  sincere  in  this  matter,  and  the  American  Association 
for  Labor  Legislation  and  the  American  Medical  Association  will 


246  American  Labor  Legislation  Review 

work  together,  it  is  going  to  be  a  great  help  to  the  men  in  the  industry 
I  represent. 

MRS.  HENSON:  With  regard  to  the  point  just  brought  out, 
the  workmen  ought  to  know,  and  they  do  know  if  they  stop  to  think 
about  it,  that  physicians  are  better  paid  by  the  corporations.  They 
should  take  this  point  close  to  heart  and  get  after  the  remedy.  Until 
the  workmen  own  the  industries,  and  therefore  are  the  employers  of 
the  physicians,  they  will  never  be  certain  of  the  best  service.  Lest 
some  may  not  have  read  enough  of  Socialism  to  know  what  I  mean, 
they  must  establish  the  cooperative  commonwealth. 

DR.  ALLEN  STARR,  New  York  City:  I  wish  to  say  a  word  about 
a  matter  which  does  not  seem  to  have  been  brought  out  in  the  dis- 
cussion,— the  necessity  for  informing  the  individual  laborer  of  his 
dangers  and  of  the  means  for  their  avoidance.  It  seems  to  me  that 
the  American  Federation  of  Labor  can  do  a  great  work  by  insist- 
ing in  its  labor  unions  upon  certain  definite  information  being  given 
to  each  laborer,  in  his  own  department,  as  to  the  methods  of  avoid- 
ing these  dangers,  and  so  preserving  his  health.  If  a  painter,  for 
example,  will  take  an  ordinary  piece  of  newspaper  and  place  it  be- 
tween his  sandwich  and  his  fingers,  he  will  not  get  the  lead  from 
his  fingers  into  his  mouth.  Yet  in  a  large  clinic  in  New  York  last 
year  I  questioned  thirty  individuals  suffering  from  lead  poisoning 
in  regard  to  whether  any  instructions  had  been  given  them,  by  their 
employers  through  notices  posted  in  the  factories,  or  in  their  labor 
unions,  as  to  methods  of  avoiding  lead  poisoning,  and  found  that 
they  had  never  heard  even  of  a  simple  device  of  that  kind. 

Many  of  these  cases  of  disease,  too,  are  the  result  of  careless- 
ness. I  have  had  some  experience  with  the  caisson  disease,  which  the 
gentleman  from  New  York  has  alluded  to.  One  of  the  most  compe- 
tent engineers  in  the  employ  of  the  Pennsylvania  Railroad  Com- 
pany insisted  on  disregarding  the  precautions  he  should  have  known 
and  was  careless  enough  to  come  out  from  a  tunnel  without  spend- 
ing enough  time  in  the  various  compartments.  I  should  like  to 
know  if  these  men  are  not  instructed  about  the  necessity  of  remaining 
in  the  compartments  a  certain  length  of  time,  and  whether  their  in- 
juries have  not  resulted  from  carelessness. 

I  should  also  like  to  make  one  other  point  in  defense  of  the  manu- 


General  Discussion  247 

facturer.  I  have  a  large  acquaintance  with  important  manufactur- 
ers in  New  York  State,  but  I  have  yet  to  find  one,  of  a  reasonable 
degree  of  intelligence,  who  is  not  as  much  interested,  from  his  stand- 
point, as  the  laborer  is  from  his.  I  will  cite  one  company  in  Jersey 
City  which  put  up  a  factory  in  which  incidentally  there  is  a  large 
amount  of  dust  discharged  into  the  air.  This  company  spent 
$40,000,  under  the  direction  of  an  incompetent  engineer  or  archi- 
tect, for  a  system  of  ventilation  by  which  the  dust  was  taken  up  to  the 
top  of  the  room,  passing  on  its  way  the  mouths  of  the  operatives. 
One  intelligent  operative  came  to  the  head  of  the  firm,  a  personal 
friend  of  mine,  and  said :  "That  is  a  defect ;  if  you  would  put  your 
exhaust  apparatus  in  the  side  of  the  floor,  gravitation  would  take  the 
dust  down  and  we  would  not  breathe  it  in."  That  gentleman  had  the 
good  sense  and  the  philanthropic  instinct  developed,  and  he  changed 
the  whole  system  and  spent  $20,000  more  in  installing  a  new 
apparatus. 

I  believe  there  is  great  hope  along  these  lines  of  disseminating  in- 
formation,— first,  information  to  the  employer  as  to  what  is  the 
necessary  thing  for  him  to  do,  and  secondly  information  to  the  em- 
ployee as  to  personal  methods  of  protection.  And  that,  it  seems 
to  me,  devolves  more  upon  the  Association  for  Labor  Legislation 
than  it  does  upon  us  physicians. 

DR.  GEIER,  Cincinnati:  I  wish  to  disagree  with  the  last  speaker 
when  he  states  that  you  must  approach  the  employer  from  the  hu- 
manitarian standpoint.  I  have  had  some  experience  with  employers 
in  Cincinnati  in  the  tuberculosis  problem.  You  don't  need  to  use 
the  cry  of  humanity  at  all.  They  prefer  to  have  you  come  in  with  a 
business  proposition.  It  is  perfectly  possible  to  go  to  them  and 
say :  "You  are  doing  this  and  that  and  the  other  thing  and  you  are 
losing  this  and  that,  so  many  hours  loss  and  so  much  inefficiency; 
put  in  this  device  for  sanitation  and  ventilation  and  you  will  make 
from  one  to  twenty  per  cent  in  the  increased  efficiency  of  your  em- 
ployees." That  is  the  thing  that  is  bound  to  appeal  to  the  business 
man.  As  a  trimming  on  the  side  we  may  speak  of  the  humanitarian 
work;  but  we  must  approach  the  business  man  with  a  business 
proposition. 

In  Cincinnati  there  is  a  factory  which  is  ready  to  pay  $2500  to 
$3000  a  year  to  a  physician  to  come  in  and  advise  them  and  examine 


248  American  Labor  Legislation  Review 

their  operatives,  etc.  I  have  been  asked  to  find  such  a  man.  As 
a  matter  of  fact  I  do  not  know  one  man  in  Cincinnati,  who  is  not 
earning  $5,000,  $6,000,  or  $10,000,  who  has  the  proper  socio- 
logical view  to  fill  that  position. 

DR.  CHARLES  E.  BREST,  Waterford,  N.  Y.:  For  some  twelve  years 
I  pointed  my  practice  to  preventive  medicine.  It  naturally  brought 
me  into  the  shops  and  into  contact  with  employers,  and  I  barked 
up  the  humanitarian  tree  for  four  or  five  years.  I  looked  up  sta- 
tistics in  regard  to  the  mortality  among  employees  in  certain  rooms 
where  the  air  was  the  same  air  as  when  the  walls  of  the  building  were 
put  up,  and  presented  them  to  the  employers.  But  up  to  the  good 
times  of  a  few  years  ago,  when  it  was  difficult  to  get  trained  em- 
ployees, they  derided  me,  and  there  is  nothing  more  difficult  to 
stand  than  ridicule.  At  that  time,  however,  I  demonstrated  that  it 
is  an  expensive  proposition  to  develop  skilled  employees  and  then 
lose  them  absolutely,  and  that  it  is  good  policy  to  care  for  them. 
Employers  close  down  for  a  week  every  year  to  fix  up  the  machin- 
ery; they  never  think  of  doing  that  for  the  employee.  But  when 
I  put  it  as  a  business  proposition  the  employers  were  willing  to  see 
the  point,  and  they  came  to  me,  not  only  in  cotton  mills,  but  in 
laundries.  I  thoroughly  agree  with  the  gentleman  from  Cincinnati. 
If  you  present  the  proposition  to  any  manufacturer  who  is  trying  to 
make  good  with  his  work  he  will  cooperate  with  you. 

PROFESSOR  HENRY  R.  SEAGER,  President,  American  Association 
for  Labor  Legislation,  New  York  City:  Some  one  has  said  that  the 
first  work  of  science  is  classification.  From  that  point  of  view  it 
would  be  impossible  to  exaggerate  the  importance  of  Dr.  Thomp- 
son's paper.  The  other  papers  give  point  to  the  suggestions  which 
he  has  made,  since  they  deal,  most  of  them,  with  specific  occupa- 
tional diseases.  We  are  especially  glad  to  have  evidence  from  the 
men  who  must  know  what  the  occupational  hazards  really  are. 

As  a  business  proposition  to  employers,  as  a  line  of  least  resist- 
ance, I  am  afraid,  when  we  consider  the  employer  in  a  large  city  and 
his  mass  of  unskilled  labor,  that  those  of  us  who  are  conscientious 
would  not  have  the  face  to  go  before  an  employer  and  tell  him  that 
it  would  be  profitable  to  look  after  the  health  of  this  man  who  is 
taken  ill  and  turned  off,  for  some  one  else  can  be  taken  on  in  his 


General  Discussion  249 

place  without  much  expense  and  with  little  trouble.  But  by  all 
means  let  us,  wherever  possible,  approach  the  problem  from  the 
point  of  view  of  business.  I  do  not  regard  that  as  optimistic.  It 
seems  to  me  those  who  approach  the  problem  from  the  humanitarian 
point  of  view  are  the  more  optimistic. 

DR.  A.  M.  HARVEY,  Chicago:  As  one  of  the  chief  duties  of  the 
physician  is  to  prevent  disease  and  preserve  health,  it  is  indeed 
gratifying  to  attend  a  joint  meeting  of  physicians  and  members  of  an 
Association  which  is  interested  in  proposing  legislation  for  the  pro- 
tection of  the  health  of  workers.  *  We  need  a  great  deal  more  knowl- 
edge of  the  subject  of  occupational  diseases  before  proper  laws  can 
be  proposed  and  enacted.  Nothing  should  be  done  hastily,  for  we 
undoubtedly  have  too  many  laws  now  on  our  books  that  are  not 
enforced. 

I  believe  that  one  of  the  chief  things  that  can  be  done  to  prevent 
occupational  disease  is  to  limit  the  age  at  which  children  may  go 
to  work,  and  another  is  to  limit  the  hours  of  work  so  that  the  worker 
may  recover  from  the  fatigue  incident  to  his  labor.  My  experience 
with  workers  during  the  past  sixteen  years  has  shown  me  that 
many  diseases  may  be  prevented  by  proper  elimination  of  dusts  and 
noxious  gases  and  by  proper  ventilation  and  lighting  of  workshops. 

As  all  speakers  have  said,  a  great  deal  can  be  done  by  cooperation, 
but  I  think  we  have  left  out  one  class  of  organizations  with  which 
we  should  cooperate,  the  manufacturers'  associations  of  the  various 
states.  In  Illinois  we  have  an  influential  manufacturers'  associa- 
tion, and  I  think  it  would  be  very  easy  to  induce  it  and  other  similar 
associations  to  take  up  the  work  as  outlined  in  this  symposium.  I 
know  that  many  of  the  larger  manufacturers  in  Illinois  have  main- 
tained health  departments  for  years,  have  a  great  deal  of  data  for 
which  you  have  been  asking,  and  would  do  a  good  deal  toward  pre- 
venting disease.  Many  of  our  manufacturers  have  taken  an  interest 
both  from  the  humanitarian  standpoint  and  from  the  economic 
standpoint,  because  they  know  it  is  hard  to  get  skilled  workers  and 
that  it  is  cheaper  to  prevent  than  to  cure. 

MRS.  FLORENCE  KELLEY,  National  Consumers'  League,  New  York 
City:  As  a  layman  I  have  listened  to  the  papers  of  the  morning  with 
the  very  greatest  interest  and  I  should  not  venture  to  criticize  the 


250  American  Labor  Legislation  Review 

medical  statements.  But  Dr.  Edsall  ventured  into  my  own  field 
when  he  suggested  that  we  should  not  be  hasty  or  drastic  in  drafting 
bills  for  the  protection  of  working  people  lest  the  manufacturer  move 
from  one  state  to  another.  Manufacturers  do  not  move  from  one 
state  to  another  to  escape  legislation  for  the  protection  of  working 
people.  Our  legislation  is  very  halting  and  faulty  compared  with 
that  of  Europe,  and  its  enactment  is  always  accompanied  by  threats 
of  removal  from  manufacturers. 

Since  May,  1889,  I  have  been  looking  for  the  manufacturer  who 
actually  moves  to  escape  such  laws.  For  four  years  I  was  head  of 
the  state  factory  inspection  of  Illinois.  The  Illinois  Glass  Company 
of  Alton  made  the  most  ominous  threats  in  order  to  escape  the  en- 
forcement of  the  child  labor  law  enacted  in  1893.  We  found  two 
hundred  and  ninety-six  violations  of  that  law  and  made  it  clear  that 
children  under  fourteen  must  be  dismissed,  that  children  under  six- 
teen must  not  work  at  night,  and  that  all  children  must  have  the 
certificates  required  by  law.  The  threat  has  been  renewed  by  that 
company  at  every  amendment  to  the  statute.  But  the  company  has 
not  moved.  It  has  stayed  where  it  was  and  has  multiplied  its  staff 
and  plant  by  three  in  the  intervening  years. 

I  did  once  appear  to  have  come  upon  a  case  in  which  a  textile 
mill  had  moved  from  Massachusetts  to  Rhode  Island  in  consequence 
of  an  amendment  which  made  the  laws  for  the  protection  of  women 
and  children  more  drastic.  When  I  hunted  it  up  I  found  that  the 
company  was  desirous  of  establishing  new  and  entirely  modern, 
up-to-date  plants  simultaneously  in  one  of  the  southern  states  and 
in  New  England.  It  received  from  the  village  to  which  it  went  in 
Rhode  Island  the  gift  of  right  to  the  land  and  valuable  concessions 
in  regard  to  water  power.  Its  removal  has  been  used  as  an  argument 
against  improved  legislation  in  Rhode  Island  and  Massachusetts; 
but  no  one,  not  even  the  manufacturers  themselves,  could  clearly 
disentangle  the  influence  of  a  slightly  increased  rigidity  in  the  laws 
regulating  the  employment  of  children  from  the  gift  of  land  and 
lasting  concessions  of  water  power. 

We  want  uniformity,  but  we  don't  want  to  let  uniformity  become 
such  a  bugaboo  that  we  are  afraid  to  do  anything  for  fear  a  state 
may  cease  to  be  uniformly  bad  with  the  other  states.  I  challenge 
anyone  here,  and  I  have  been  challenging  anyone  from  whom  I  had 
any  hopes  of  enlightenment  for  twenty-three  years,  to  produce  an 


General  Discussion  251 

authentic  case  of  the  removal  of  a  manufacturer  from  one  state 
to  another  because  of  the  protection  of  the  workingman. 

4 

MR.  MILES  M.  DAWSON,  New  York  City:  I  feel  as  if  I  were 
taking  the  position  Scipio  Af ricanus  is  said  to  have  taken  before  the 
Roman  Senate,  "Carthage  must  be  destroyed",  when  I  arise  to  speak 
concerning  the  intimate  and  necessary  relations  between  the  various 
branches  of  the  work  we  are  unfolding  and  starting  in  the  United 
States.  We  can  never  accomplish  what  we  wish  in  the  matter  of 
industrial  hygiene  and  the  prevention  of  industrial  diseases  until  we 
have  throughout  the  United  States  a  system  of  compulsory  sick 
insurance.  The  statement  made  by  the  lady  who  spoke  of  the  neces- 
sity for  the  workman  being  interested  in  the  employment  of  the 
physician,  whatever  we  may  think  about  her  general  conclusion,  is 
justifiable.  The  physicians  have  not  given  the  caisson  sickness 
proper  attention.  We  need  in  the  United  States  something  which 
will  take  care  of  our  people  and  we  shall  not  be  able  to  do  it  effec- 
tively until  they  are  obliged  to  have  sickness  insurance. 

PROFESSOR  SAMUEL  McCuNE  LINDSAY,  Columbia  University, 
New  York  City:  In  view  of  the  fact  that  every  speaker  has  con- 
fessed that  our  ignorance  of  occupational  diseases  is  so  great  that 
any  legislation  at  present  would  be  hasty,  we  are  likely  to  have 
hasty  and  ill-considered  legislation.  But  there  are  some  kinds  of 
legislation  we  are  now  ready  for,  and  it  is  important  that,  at  this 
joint  meeting  of  the  Medical  and  Labor  Legislation  Associations, 
we  should  turn  our  thought  to  the  kind  of  legislation  for  which 
we  are  ready. 

I  shall  pass  over  the  sort  of  legislation  that  has  resulted  so  satis- 
factorily in  the  prevention  of  phosphorus  poisoning,  where  our 
knowledge  was  a  little  further  advanced  than  in  regard  to  other 
kinds  of  industrial  poisoning.  We  need  authoritative  information 
and,  as  has  been  suggested  by  several  speakers,  we  are  all  agreed  that 
such  information  can  be  had,  in  the  last  analysis,  only  with  the  co- 
operation and  support  of  the  state.  In  other  words,  we  must  se- 
cure legislation  in  several  states  that  will  set  to  work  the  machinery 
we  need  to  get  that  information.  I  have  just  returned  from  Wash- 
ington, where  I  have  been  in  connection  with  the  work  of  the  com- 
mittee which  has  undertaken  to  urge  the  passage  of  a  bill  providing 


252  American  Labor  Legislation  Review 

for  an  impartial  national  commission  to  inquire  into  all  the  relations 
between  employers  and  employees.  Such  a  commission,  I  take  it, 
would  properly  bring  within  the  scope  of  its  inquiry  the  subject  we 
are  discussing.  That  measure  should  have  the  support  of  all  here 
present. 

Reference  was  made  by  one  of  the  speakers  to  the  disagreeable 
feature  of  reporting  cases  of  industrial  disease,  the  burden  on  the 
physician.  I  think  the  gentleman  suggested  that  he  had  a  little  doubt 
about  the  advantage  of  these  laws.  But  it  ought  to  be  pointed  out 
that  the  use  of  such  a  schedule  as  that  of  the  bureau  of  labor  of 
New  York  will  have  a  good  effect.  It  will  call  the  physician's  atten- 
tion to  the  industrial  side  of  the  health  problem  and  will  have  a 
value  in  his  work  which  will  make  the  burden  not  without  its  re- 
ward. At  any  rate,  it  seems  to  me  that  this  is  a  type  of  legislation 
for  which  we  are  ready,  and  that  the  American  Association  for 
Labor  Legislation  is  justified  in  pushing  its  campaign  to  have  re- 
porting laws  passed  in  all  the  great  states. 


II 

INVESTIGATION  OF  INDUSTRIAL  DISEASES 


Presiding  Officer:  HENRY  R.  SEAGER 

President,  American  Association  for  Labor  Legislation 

NEW  YORK  CITY 


INTENSIVE  INVESTIGATIONS  IN  INDUSTRIAL 
HYGIENE 


FREDERICK  L.  HOFFMAN 
Statistician,  Prudential  Insurance  Company. 


Industrial  hygiene  is  gradually  assuming  the  position  of  an  applied 
science  in  its  relation  to  government  and  the  public  at  large.  The 
nation-wide  agitation  for  effective  workmen's  compensation  legisla- 
tion and  the  establishment  of  state  insurance  for  this  purpose  in 
Washington,  Ohio,  and  Massachusetts,  emphasizes  the  necessity  for 
trustworthy  information,  statistical  or  otherwise,  with  regard  to  the 
whole  question  of  health  and  safety  in  American  industry.  It  is  not 
going  too  far  to  say  that  most  of  the  published  information  on  the 
subject  of  industrial  hygiene  and  industrial  accidents  is  of  very 
limited  practical  value,  and  much  of  it  is  decidedly  misleading. 

There  have  been  very  few  intensive  studies  of  the  actual  condi- 
tions under  which  American  industry  is  carried  on  at  the  present 
time.  In  the  memorial  to  the  President  on  the  appointment  of  a 
national  commission  for  the  investigation  of  industrial  diseases, 
practically  all  the  conclusive  evidence  was  derived  from  foreign 
sources  or  intensive  and  more  or  less  conclusive  investigations  made 
in  foreign  countries.  It  is  most  encouraging,  however,  that  within 
recent  years  the  necessity  for  such  investigations  should  have  been 
recognized,  and  mention  only  requires  to  be  made  of  what  has  been 
done  in  this  respect  by  the  states  of  Massachusetts,  New  York,  Illi- 
nois, etc.  The  honor  belongs  to  the  state  of  Illinois  for  having  been 
the  first  to  appoint  a  special  commission  to  investigate  and  report 
upon  the  subject  of  industrial  diseases,  and  the  report  of  that  com- 
mission constitutes  a  valuable  contribution  to  the  literature  of 
industrial  hygiene.  The  publications  of  the  Massachusetts  State 
Board  of  Health,  and  of  the  New  York  State  Department  of  Labor 
require  also  to  be  mentioned  as  helpful  indications  of  the  direction 
which  in  years  to  come  investigations  of  this  kind  are  bound  to  take 
to  an  increasing  extent.  The  monograph  by  Dr.  Andrews  on  phos- 
phorus poisoning  and  the  reports  by  Dr.  Hamilton  on  lead  poisoning 


256  American  Labor  Legislation  Review 

are  epoch-making  documents  which  separate  precisely  the  field  of 
guesswork  opinion  from  the  field  of  impartially  ascertained  facts. 

The  principles  which  underlie  all  investigations  of  this  kind  are 
not  as  yet  fully  defined.  It  may  be  said  at  the  outset,  however,  that 
every  industry  should  be  inquired  into  with  reference  to  the  health 
and  safety  of  persons  employed  therein,  but  with  a  due  regard  to 
the  essential  conditions  under  which  such  industries  can  be  econom- 
ically, profitably,  and  efficiently  carried  on.  It  is  important  in  all 
investigations  of  this  kind  that  the  investigator  first  make  him- 
self thoroughly  familiar  with  the  technique  of  the  industry  or 
trade  about  to  be  investigated,  since  whatsoever  conclusions  may  be 
arrived  at,  they  must  be  more  or  less  conditioned  by  the  elements  of 
the  industry  itself.  A  clear  understanding  of  the  technical  details 
of  any  given  industry  or  trade  often  requires  much  patient  study  and 
research,  but  without  such  an  understanding  of  the  methods  by 
which  a  particular  industry  or  trade  is  carried  on  most  of  the 
conclusions  as  to  health  and  safety  must  be  more  or  less  wanting  in 
the  essential  requirements  of  absolute  accuracy  and  impartiality. 

It  is  unfortunate  for  research  in  the  field  of  American  industrial 
hygiene  that  most  of  the  textbooks  descriptive  of  industrial  or 
manufacturing  processes  should  be  by  foreign  authorities,  just  as  is 
the  case  with  regard  to  textbooks  on  occupational  diseases  and  the 
prevention  of  accidents.  Some  notable  exceptions  are  the  standard 
works  of  reference  on  metallurgical  processes  and  industrial  chem- 
istry. The  treatise  on  Industrial  Organic  Chemistry  by  Sadtler,  and 
the  Outlines  of  Industrial  Chemistry  by  Thorp,  are  indispensable  to 
research  work  in  a  large  number  of  industries  chiefly  or  partly  in- 
clusive of  chemical  processes  of  manufacture.  The  earlier  Diction- 
ary of  Arts,  Manufactures,  and  Mines  by  Ure,  in  three  volumes,  and 
the  still  earlier  Cyclopedia  of  Useful  Arts  by  Tomlinson,  and  Cham- 
bers' Information  for  the  People,  published  in  1847,  are  useful  for 
the  purpose  of  illustrating  the  methods  and  processes  of  manufacture 
in  the  past.  Some  of  the  descriptive  accounts  of  industrial  processes 
published  by  the  Census  Office  from  time  to  time  since  1880  are  of 
considerable  practical  value  in  investigations  of  this  kind,  but  it  is 
much  to  be  regretted  that  there  should  not  be  a  popular  treatise  on 
the  technology  of  trades  and  industries  giving,  at  least  in  brief  out- 
line, an  intelligent  account  of  modern  methods  of  manufacture,  with 
particular  reference  to  the  safety  and  health  of  the  employees,  and 
including  the  smaller,  but  frequently  more  important  trades. 


Intensive  Investigations  in  Industrial  Hygiene  257 

As  illustrations  of  the  textbooks  useful  for  the  purpose  of  obtain- 
ing a  sound  preliminary  understanding  of  the  essential  factors  in 
industry,  I  may  refer  to  the  treatise  on  The  Manufacture  and  Prop- 
erties of  Iron  and  Steel,  by  Campbell ;  Modern  Copper  Smelting,  by 
Peters ;  The  Textbook  of  Ore-Dressing,  by  Richards ;  and  Lead  and 
Zinc  Pigments,  by  Holley.  For  many  of  the  industries  excellent 
monographs  have  been  published  by  corporations  which,  by  their 
illustrations  alone,  render  substantial  aid  to  the  students  of  industrial 
processes  in  their  relation  to  health  and  life.  I  may  refer  to  a  short 
treatise  on  The  Destructive  Distillation  of  Bituminous  Coal,  with  ref- 
erence to  the  United-Otto  system  of  by-product  coke  ovens,  which 
practically  constitutes  a  guide  to  that  rather  intricate  process  which 
has  made  the  utilization  of  valuable  waste  products  a  commercial 
possibility.  The  federal  and  state  geological  surveys  publish  reports 
which  frequently  contain  interesting  observations  and  suggestive 
illustrations,  but  I  can  only  refer  to  the  report  of  the  geological 
survey  of  the  State  of  New  York  on  the  lime  and  cement  industries 
of  that  state,  and  to  the  report  on  the  manufacture  of  roofing  tiles, 
published  by  the  geological  survey  of  Ohio. 

Next  to  a  sound  technical  foundation  it  is  of  some  importance  that 
the  historical  facts  of  any  given  industry  be  taken  into  account,  and 
while  the  history  of  American  manufactures  has  not  been  brought 
down  to  date,  Bishop's  classical  work  is  still  of  value,  mono- 
graphs are  occasionally  printed  by  institutions  of  learning,  and 
the  report  on  manufacturing  industries  by  the  Census  Office  also 
contains  much  useful  information.  I  can  only  refer  to  the  excellent 
monograph  on  The  Printers,  by  Professor  Barnett,  published  by  the 
American  Economic  Association,  and  to  the  historical  account  of  the 
English  tin  miners,  by  Lewis,  published  in  the  series  of  Harvard 
Economic  Studies. 

The  most  useful  sources  of  information  with  regard  to  industrial 
processes  are  the  technical  trade  journals,  which  for  practically  all 
of  the  industries  extend  over  a  considerable  period  of  time.  These 
publications,  to  an  increasing  extent,  take  into  account  the  economic 
and  social  conditions  of  labor,  and  with  special  regard  to  wages, 
hours  of  labor,  etc.  The  reports  and  bulletins  of  the  federal  Bureau 
of  Labor  and  of  the  state  departments  of  labor,  moreover,  make  an 
immense  amount  of  more  or  less  trustworthy  information  conven- 
iently available.  Such  reports  of  the  federal  Bureau  of  Labor  as 


258  American  Labor  Legislation  Review 

have  recently  been  published  on  the  steel  industry,  and  the  series  of 
reports  on  the  condition  of  women  and  children,  emphasize  im- 
portant elements  of  inquiry  which  require  to  be  taken  into  account. 

It  is  the  disregard  of  this  necessity  for  preliminary  education 
which  usually  accounts  for  failure  to  secure  the  best  possible  results. 
Intensive  industrial  investigations  are  a  burden  upon  industry  and 
they  should  be  made  only  by  those  qualified  for  the  task,  and  by 
men  or  women  thoroughly  trained  in  advance  with  regard  to  all  the 
facts  and  conditions  which  they  can  ascertain  from  existing  sources 
of  information.  Industry  does  not  exist  for  the  purpose  of  providing 
material  for  the  writing  of  books  or  descriptive  monographs,  but 
solely  for  purposes  of  production  at  a  rate  of  profit  consistent  with 
safe  and  economical  management.  The  large  majority  of  manufac- 
turers throughout  the  United  States  are  deserving  of  unstinted 
praise  for  the  manner  in  which  their  establishments  are  conducted 
and  made  to  conform  to  legal  and  moral  requirements  with  regard 
to  the  safety,  health,  and  comfort  of  employees.  The  difficulty  is 
not  so  much  in  what  is  obvious  as  in  what  is  not  obvious.  Immense 
progress  has  been  made  and  the  tendency  practically  everywhere  is 
decidedly  toward  betterment  consistent  with  the  conditions  under 
which  industry  can  be  profitably  carried  on. 

The  problem  is  one  of  ignorance  rather  than  of  neglect.  Most  of 
the  factors  which  condition  health  and  safety  in  industry  are  as  yet 
very  imperfectly  understood,  at  least  in  the  United  States.  It  is 
true  that  within  the  last  quarter  of  a  century  immense  progress  has 
been  made  in  Germany,  but  largely  because  of  the  requirements  of 
compulsory  accident  insurance  institutions  established  to  replace  an 
antiquated  system  of  employers'  liability  law.  We  have  not  as  yet 
developed  in  this  country  the  function  of  the  safety  engineer,  who 
has  attained  to  such  high  professional  standing  throughout  the 
German  Empire  because  of  the  practical  utility  of  his  services. 
Manufacturers  or  employers  of  labor  generally  are  not  blamable  for 
their  reluctance  to  install  expensive  safety  devices,  or  ventilating 
devices,  or  other  methods  or  means  by  which  health,  safety,  and 
comfort  can  be  improved,  unless  the  evidence  is  conclusive  that  the 
investment  will  be  productive  of  the  desired  results.  The  function 
of  the  ventilating  engineer  in  his  relation  to  industrial  requirements 
is  practically  new,  and  almost  the  same  may  be  said  of  the  function 
of  the  illuminating  engineer.  All  of  these  questions  require  to  be 


Intensive  Investigations  in  Industrial  Hygiene  259 

taken  into  account  by  the  critic  of  industrial  conditions  in  so  far 
as  they  have  relation  to  the  safety,  health,  and  comfort  of  the 
employees.  .  im 

A  manufacturing  plant  is  private  property  and  admission  thereto 
obtained  by  visitors  or  investigators  is  a  matter  of  courtesy  on  the 
part  of  the  corporation  or  firm.  All  manufacturing  establishments 
are  subject  to  the  visitorial  powers  and  duties  of  state  labor  bureaus, 
or  state  factory  inspection  bureaus,  and  to  a  certain  extent  of  state 
boards  of  health.  The  inspectors  of  these  respective  governmental 
departments  are  free  to  make  their  investigations  without  let  or 
hindrance,  and  their  conclusions,  so  far  as  practicable,  should  be 
made  public  as  a  matter  of  record.  Until,  however,  the  status  of  the 
factory  inspector,  or  the  health  inspector,  is  raised  to  the  dignity 
and  far-reaching  responsibility  inherent  in  the  position,  it  is  self- 
evident  that  radical  conclusions  must  be  accepted  with  caution,  and 
exceedingly  favorable  reports  must  be  looked  upon  with  more  or 
less  distrust.  It  is  not  going  too  far  to  say  that  most  of  the  published 
reports  of  factory  inspectors  in  this  country  are  of  very  limited 
practical  utility  for  research  work  in  the  field  of  industrial  hygiene; 
while,  in  marked  contrast,  the  annual  reports  of  the  chief  factory 
inspectors  of  England,  Germany,  Austria,  France,  Switzerland,  Bel- 
gium, etc.,  are  models  of  their  kind  and  trustworthy  sources  of 
information  with  regard  to  conditions  more  or  less  detrimental  to 
health  and  life  in  industry. 

The  investigator,  having  obtained  permission,  as  a  matter  of 
courtesy,  to  visit  an  industrial  establishment,  should  refrain  from 
any  conversation  with  the  employees  except  by  the  specific  permis- 
sion of  the  employer.  A  labor  force,  under  the  best  conditions,  is 
easily  disturbed  by  the  visits  of  strangers,  and  most  of  all  by  men  or 
women  who  are  supposed  to  be  in  search  of  information  or  facts 
more  or  less  detrimental  to  the  industry  investigated.  There  are 
everywhere  employees  with  grievances,  whose  evidence  may  be  given 
in  good  faith,  but  who  cannot  be  relied  upon  in  matters  of  fact.  The 
investigator  should  be  a  trained  observer  and  should  take  notes  at 
the  time  of  inspection  of  everything  seen  or  heard  which  has  any 
possible  bearing  upon  the  purpose  of  the  investigation — that  is, 
whether  conditions  exist  which  are  a  menace  to  the  safety  and  health 
of  the  employee. 

The  investigator  must  keep  in  mind  that  employers  of  labor  who 


260  American  Labor  Legislation  Review 

have  given  years  to  the  operation  of  a  particular  plant,  possibly 
representative  of  extremely  complex  methods  of  manufacture,  are 
not  likely  to  be  indifferent  to  the  desirability  that  the  best  possible 
conditions  of  work  be  maintained.  At  the  same  time  it  quite  fre- 
quently happens  that  the  most  obvious  need  escapes  attention, 
since  the  mind  of  the  employer  is  preoccupied  with  matters  of 
more  immediate  personal  concern.  Every  manufacturer  or  em- 
ployer of  labor  welcomes  intelligent,  concrete  suggestions  as  to 
methods  and  means  by  which  the  conditions  affecting  the  health  and 
safety  of  his  employees  can  be  materially  improved.  The  investi- 
gator may  safely  take  it  for  granted  that,  broadly  speaking,  the  man- 
ufacturer or  employer  is  as  much  interested  in  the  ascertainment  of 
the  truth  regarding  actual  conditions  as  the  outside  public  or  the 
investigator  himself.  He  is  fully  assured  of  the  most  hearty  co- 
operation in  the  large  majority  of  cases  in  which  intensive  investiga- 
tions are  made  under  proper  conditions  and  by  thoroughly  qualified 
persons  fit  to  go  into  delicate  matters  of  this  kind. 

The  information  obtained  may  be  considered  confidential  or  not, 
according  to  the  previous  understanding  with  the  manufacturer  or 
employer  whose  particular  plant  has  been  made  the  subject  of  an 
inquiry.  As  a  rule,  there  should  be  a  precise  agreement  on  this 
point,  and  if  a  written  report  is  made  a  copy  thereof  should  be  sent 
to  the  manufacturer  or  employer  for  verification  or  for  such  com- 
ments as  misstatements  or  errors  in  matters  of  fact  may  require. 

It  is  hardly  possible,  on  an  occasion  of  this  kind,  to  enumerate  all 
of  the  factors  which  should  be  taken  into  account.  It  requires  no 
discussion  to  prove  that  such  problems  as  air  conditioning  in  textile 
mills,  the  mechanical  properties  of  industrial  dust  or  the  effective 
removal  of  such  dust  by  ventilating  devices,  the  alleged  pathogenic 
properties  of  mine  air,  or  the  injurious  effect  of  intense  light  in 
electro-metallurgical  processes,  all  demand  special  and  highly  techni- 
cal qualifications  for  the  rendering  of  a  judgment  or  opinion  that 
may  be  relied  upon  as  sound.  But  with  regard  to  most  of  the  con- 
ditions which  injuriously  affect  the  health  of  employees,  or  which 
have  a  relation  to  the  employees'  safety  as  conditioned  by  safety 
devices,  ordinary  intelligence,  plus  the  power  of  intelligent  observa- 
tion, is  sufficient.  But  granting  this,  an  intensive  industrial  investi- 
gation is  a  difficult  task,  than  which  perhaps  no  public  function 
requires  to  be  approached  with  mlore  genuine  humility  and  diffidence. 


Intensive  Investigations  in  Industrial  Hygiene  261 

It  is  not  a  difficult  matter  to  conceive  of  ideal  conditions  of  work, 
and  most  of  all  is  it  easy  to  condemn  the  employer  and  relieve  the 
employee  of  all  responsibility.  But  it  requires  a  trained  mind  to 
ascertain  the  necessary  facts  and  to  draw  conclusions  which  can  be 
practically  applied  to  the  more  or  less  apparent  needs  for  drastic 
reform.  Investigations  of  this  kind  are  laborious  and  should  not  be 
undertaken  by  those  who  are  easily  fatigued  or  confused. 

The  sole  object  in  view  is  to  ascertain  the  truth  and  to  ameliorate, 
as  far  as  possible,  the  conditions  of  labor,  so  that  those  who  are  the 
real  producers  of  the  nation  may  not  pay  the  price  of  industry  in  an 
excessive  amount  of  disease  or  premature  invalidity  and  death.  There 
is  no  more  useful  function  in  society  than  that  of  the  earnest  seeker 
after  truth  in  matters  of  this  kind,  and  there  is  nothing  more  credit- 
able to  any  nation  than  actual  progress  in  industrial  hygiene  and  the 
prevention  of  needless  industrial  accidents.  On  a  very  conservative 
basis,  twenty-five  thousand  lives  are  annually  lost  in  the  United 
States  as  the  result  of  industrial  accidents,  which  is  the  tribute  paid 
in  lives  by  some  thirty  million  toilers  who  carry  on  the  nation's  work. 
What  the  tribute  is  in  ill  health  and  invalidity  no  one  is  at  present  in 
a  position  to  estimate  even  with  approximate  accuracy  upon  the 
slender  basis  of  data  available.  But  granting  that  the  relative  occur- 
rence of  industrial  disease  is  greater  in  Germany  than  in  this  country, 
and  taking  only  half  the  calculated  amount  of  sickness  on  the  German 
basis,  the  figures  are  as  startling  as  they  are  suggestive  of  the  im- 
perative need  for  the  most  patient,  the  most  disinterested,  but  at  the 
same  time  the  best  qualified  methods  of  research  in  industrial 
hygiene.  I  \ 

It  requires  no  argument,  therefore,  to  emphasize  the  need  for  a 
thorough  understanding  of  the  essential  facts  of  industrial  hygiene 
as  a  preliminary  requisite  for  intensive  investigations  into  the  con- 
ditions inimical  to  health  and  life  in  industry.  The  historical  method 
has  obvious  advantages  in  that  it  brings  out  with  reasonable  accuracy 
the  progress  which  has  been  made  by  the  complete  elimination  of 
some  of  the  worst  conditions  injurious  to  the  health  of  wage-earners 
in  the  past.  The  treatise  by  Ramazzini,  published  for  the  first  time 
in  English  in  1705,  is  a  textbook  which  may  still  be  consulted  to 
practical  advantage,  and  it  is  to  be  hoped  that  some  time  this  exceed- 
ingly rare  work  will  be  reprinted.  Tissot's  Essay  on  the  Disorders 
of  the  People  of  Fashion,  and  the  Diseases  Incident  to  Literary  and 


262  American  Labor  Legislation  Review 

Sedentary  Persons,  published  in  1772,  is  also  quite  suggestive;  and 
the  same  may  be  said  of  Thackrah's  treatise  on  The  Effects  of  Arts 
and  Professions  on  Longevity,  published  in  1832.  There  is  much 
valuable  information  in  Gaskell's  book  on  Artisans  and  Machinery, 
and  the  Moral  and  Physical  Condition  of  the  Manufacturing  Popula- 
tion ;  but  one  of  the  most  suggestive  works  on  occupational  diseases 
is  The  Vital  Statistics  of  Sheffield,  by  Holland,  published  in  1843. 
There  could  be  no  more  serious  error  than  to  assume  that  the  health- 
injurious  consequences  of  occupations  are  limited  to  the  mechanical 
industries,  and  it  only  requires  to  be  pointed  out  that  the  propor- 
tionate mortality  from  tuberculosis  of  the  lungs  at  ages  from  twenty- 
five  to  thirty- four  among  salesmen  is  46.7  per  cent.  In  1884  Thomas 
Sutherst,  a  barrister-at-law,  published  a  very  suggestive  work,  with 
numerous  cases,  on  Death  and  Disease  Behind  the  Counter,  intended 
as  a  protest  against  the  more  or  less  unnatural  conditions  of  shop 
labor. 

These  are  the  earlier  works  of  reference,  which  have  since  been 
partly  replaced  by  the  Handbook  on  Occupational  Diseases,  by  Ar- 
lidge,  followed  by  the  standard  work  of  reference  on  Dangerous 
Trades,  prepared  under  the  editorial  supervision  of  Sir  Thomas 
Oliver,  who  about  two  years  ago  published  a  compact  textbook  on 
Diseases  of  Occupation,  which  can  be  consulted  to  great  practical 
advantage  on  the  group  of  occupations  to  which  the  work  is  limited. 
There  are  a  number  of  German  and  French  textbooks  on  industrial 
hygiene  which  have  not  their  counterpart  in  English.  Foremost 
among  these  is  the  great  work  prepared  under  the  editorial  super- 
vision of  Weyl,  including  observations  on  the  "General  Principles  of 
Industrial  Hygiene  and  Factory  Legislation'*  which  have  for  their 
specific  object  improvements  in  conditions  affecting  safety  and  health 
in  industry.  An  excellent  manual  in  German  is  a  treatise  on  Indus- 
trial Hygiene,  by  Holitscher,  and  there  is  a  book  by  the  same  title 
published  in  1906  by  Dr.  Bender,  a  medical  factory  inspector  of  large 
experience.  Special  reference  should  be  made  to  two  small  manuals 
of  advice  to  German  boys  and  girls  about  to  enter  a  trade,  which 
have  particular  regard  to  the  physical  requirements  and  the  mental 
adaptation  to  particular  industrial  processes.  Manuals  of  this  kind, 
obtainable  at  a  cost  of  a  few  cents,  convey  the  required  information 
in  the  most  effective  manner,  but  the  suggestions  contained  therein 
are  also  of  practical  value  to  the  student  of  industrial  hygiene. 


Intensive  Investigations  in  Industrial  Hygiene  263 

Research  work  on  a  larger  scale  is  much  facilitated  by  the  Index 
Catalogue  of  the  Army  Medical  Museum  and  Library,  for  some  of 
the  most  useful  and  instructive  discussions  of  special  phases  of 
industrial  hygiene  and  the  medical  consequences  of  industrial  acci- 
dents are  the  occasional  contributions  by  practicing  physicians  to 
the  medical  periodical  press.  A  thorough  study  of  the  available 
medical  literature  relating  to  occupational  diseases  and  occupational 
neuroses  is  imperative,  for  even  the  most  earnest  seeker  after  in- 
formation may  fail  of  his  or  her  purpose  on  account  of  lack  of  the 
required  preliminary  training.  As  has  been  previously  pointed  out, 
the  recent  legislation  on  workmen's  compensation  and  the  tendency 
in  the  direction  of  drastic  and  far-reaching  laws  make  investigations 
into  the  field  of  industrial  hygiene  and  accidents  of  great  practical 
importance.  Those  who  have  had  to  do  with  the  settlement  of 
Claims  Arising  from  the  Results  of  Personal  Injuries  appreciate  the 
value  of  a  work  with  this  title  by  Magruder,  and  of  the  larger  treatise 
on  the  Causes  of  Disability,  by  Harbaugh.  A  most  useful  handbook 
in  this  connection  is  Saunders'  Medical  Hand  Atlas  of  Diseases 
Caused  by  Accidents. 

In  brief,  the  present  plea  is  for  scientific  methods  in  intensive 
investigations  in  the  field  of  industrial  hygiene  as  a  first  requirement 
for  the  attainment  of  really  useful  and  conclusive  results.  Probably 
no  other  field  of  systematic  research  offers  such  exceptional  oppor- 
tunities to  the  earnest  seeker  after  truth,  and  certainly  none  is  more 
likely  to  prove  of  great  benefit  to  the  mass  of  mankind.  In  justice 
to  employers,  whose  every  effort  to  improve  conditions  inimical  to 
health  deserves  encouragement,  and  in  equal  justice  to  employees, 
whose  health  and  well-being  are  menaced  at  the  present  time  by 
conditions  more  or  less  unsatisfactory,  it  is  of  the  utmost  importance 
that  so  difficult  a  task  should  be  approached  with  a  due  consideration 
of  the  seriousness  of  the  problem,  the  need  of  a  scientific  method, 
and  the  duty  of  absolute  impartiality.  The  object  of  all  investiga- 
tions of  this  kind  is  not  to  prove  or  sustain  any  particular  conclusion 
arrived  at  in  advance,  but  to  determine  the  truth  and  the  facts  as 
they  actually  exist  and  as  they  condition  at  the  present  time  the 
health  and  well-being  of  the  men,  women,  and  young  persons  em- 
ployed in  productive  industries, 


COMPULSORY    REPORTING    BY    PHYSICIANS 


LEONARD    W.  HATCH 
New  York  State  Department  of  Labor. 


Compulsory  reporting  of  industrial  diseases  by  physicians  consti- 
tutes the  first  step  in  the  campaign  for  prevention,  if  the  latter  is  to 
be  comprehensive  and  scientific.  It  is  a  case  of  an  extensive  evil 
known  to  exist  in  various  forms,  in  divers  places,  and  from  a  variety 
of  causes,  but  also  known  to  be  in  large  measure  eradicable  if  only 
we  can  discover  its  various  forms,  their  location,  and  their  causes. 
If,  therefore,  preventive  efforts  are  to  be  directed  so  that  they  may 
be  a^t  once  comprehensive  in  scope  and  intelligently  effective  in 
detail,  knowledge  of  the  frequency,  incidence,  and  sources  of  the 
evil  are  of  prime  importance. 

Furthermore,  it  is  safe  to  say  that  the  prevention  campaign  only 
awaits  the  necessary  knowledge  of  the  evil  to  be  assured  of  success. 
The  propriety  of  the  exercise  of  the  police  power  of  the  govern- 
ment in  the  interests  of  public  health,  which  means  the  health,  not 
only  of  all  the  public,  but  of  any  particular  portion  which  may  be 
subject  to  peculiar  health  hazards,  has  long  been  recognized,  and 
public  sentiment  was  never  more  quick  than  now  to  back  laws  for 
such  a  purpose,  while  private  initiative,  stimulated  by  public  senti- 
ment or  moved  by  humanitarian  motives,  has  never  inspired  greater 
activity  than  now  along  these  lines. 

If,  then,  prevention  waits  only  for  adequate  information,  where 
shall  this  information  be  secured?  Obviously  for  information  con- 
cerning diseases  the  principal  source  technically  equipped  to  serve 
as  a  reliable  informant  is  the  medical  profession.  Further,  it  is 
not  essentially  a  case  of  calling  upon  physicians  to  go  out  of  their 
particular  field  of  work,  because  practically  all  cases  of  occupa- 
tional disease,  serious  enough  to  be  important,  come  to  physicians 
automatically,  so  to  speak,  in  the  course  of  their  regular  professional 
practise.  In  this  aspect,  compulsory  reporting  of  occupational 
diseases  is  precisely  like  compulsory  registration  of  deaths.  It  is 
simply  the  necessary  requirement  for  bringing  together  by  registra- 


Compulsory  Reporting  by  Physicians  265 

tion  at  one  place  scattered  data  which  come  under  the  eye  of  dif- 
ferent physicians  in  their  regular  work.  That  this  registration  of 
industrial  diseases  is  usually  to  be  made  with  a  different  depart- 
ment of  government  than  registration  of  deaths,  is  due  simply  to 
the  fact  that  special  government  agencies,  in  the  shape  of  labor 
departments,  have  been  developed  for  the  safeguarding  of  the 
health  of  workers,  just  as  health  boards  or  departments  have  been 
developed  for  the  conservation  of  the  general  health  of  the  com- 
munity. Registration  of  deaths,  being  significant  for  all  phases  of 
the  public  health,  goes  naturally  to  the  department  of  government 
with  the  broader  function.  Registration  of  the  diseases  of  industry 
goes,  likewise  naturally,  to  the  department  whose  special  field  is 
health  in  industry. 

But  more  important  than  analysis  of  the  fundamental  reason  for 
laying  upon  physicians  the  obligation  of  registration  of  industrial 
diseases,  is  consideration  of  just  what  kind  of  information  should 
be  asked  of  them  in  connection  with  such  registration. 

It  almost  goes  without  saying,  of  course,  that  the  first  thing  to  be 
required  in  a  registration  certificate  is  the  strictly  professional 
matter  of  the  physician's  diagnosis  of  the  disease.  But  if  registra- 
tion is  to  furnish  all  that  is  necessary,  the  physician  must  be  asked 
to  go  beyond  the  narrowly  professional  function  of  diagnosis  to 
consideration  of  antecedent  causes  of  the  patient's  condition.  The 
importance  of  the  physician's  taking  this  point  of  view  can  hardly 
be  overemphasized.  It  is  necessary  because,  to  a  large  extent,  it  is 
the  only  means  by  which  the  physician  can  discover  that  diseases 
are  occupational.  When  we  speak  of  industrial  diseases  we  are  not 
dealing  with  a  class  all  of  which  are  clearly  distinguished  from 
other  diseases  by  peculiarities  of  their  own,  so  that  identification 
alone  affords,  or  necessarily  suggests,  their  occupational  character. 
On  the  contrary,  we  are  dealing  in  large  measure — probably  when 
the  full  truth  is  known  it  will  be  found  to  be  in  largest  measure — 
with  ordinary  diseases  found  elsewhere  but  which  may  be  due  to 
occupation  and  which  can  be  identified  as  occupational  only  by 
inquiry  as  to  the  circumstances  of  the  patient's  calling.  In  a  word, 
many  occupational  diseases  are  distinguished  from  others  primarily 
by  their  causes,  so  that  only  by  their  causes  can  they  be  identified. 

To  put  this  matter  in  the  concrete,  there  is  one  industrial  disease, 
compressed-air  illness  or  caisson  disease,  which  is  practically  always 


266  American  Labor  Legislation  Review 

due  to  circumstances  of  occupation.  And  there  are  a  few  poison- 
ings, the  most  notable  example  of  which  is — or  rather  we  may  now 
say,  fortunately,  has  been — phosphorus  necrosis,  which  are  known 
to  be  due  so  frequently  to  occupation  that  they  have  acquired  the 
name  of  industrial  poisonings.  There  are  also  one  or  two  infectious 
diseases,  the  leading  example  of  which  is  anthrax,  which  likewise 
are  so  commonly  associated  with  an  occupation  that  they  imme- 
diately suggest  occupational  causes.  Even  in  these  fairly  well- 
recognized  industrial  diseases,  however,  the  physician  must  go 
back  of  diagnosis  to  identify  them  as  occupational  in  character,  as 
witness  instances  lately  reported  in  New  York  State  of  lead  poison- 
ing in  the  case  of  a  schoolboy,  of  phosphorus  and  mercury  poison- 
ings in  cases  of  children,  and  of  anthrax  in  the  case  of  a  stock 
broker. 

A  more  striking  illustration  of  this  point  is  another  New  York 
case  in  which  only  the  accidental  discovery  of  occupational  causes 
prevented  an  absolutely  incorrect  diagnosis  of  a  case  of  industrial 
poisoning.  In  a  brewery  in  the  state  two  men  were  employed  last 
year  in  varnishing  the  inside  of  closed  wooden  vats  with  alcohol 
and  shellac.  After  a  day  of  such  work  one  of  them  became 
violently  ill  and  died  during  the  night  without  medical  attendance. 
The  coroner's  physician,  on  examination,  found  the  cause  of  death 
obscure,  but,  on  the  strength  of  what  he  could  discover  by  inquiry 
concerning  the  patient's  illness,  certified  the  cause  of  death  as 
apoplexy.  On  the  day  of  the  funeral  the  physician  heard  that  the 
other  workman  had  become  blind,  and  for  the  first  time  learned 
what  kind  of  work  the  two  men  had  been  doing.  Thereupon  he 
procured  a  sample  of  the  alcohol  and  shellac,  had  it  analyzed,  and 
found  that  the  alcohol  was  wood-alcohol,  with  the  result  that  both 
the  nature  of  the  disease  and  its  occupational  cause  were  revealed, 
and  his  certificate  as  medical  examiner  was  accordingly  altered  to 
make  the  cause  of  death  wood-alcohol  poisoning.  This  is,  of  course, 
an  extreme  case,  but  experience  in  connection  with  the  registration 
of  deaths  affords  evidence  that  such  errors  are  frequent  enough  to 
sustain  the  point  here  emphasized,  namely,  that  even  in  the  case  of 
the  more  exclusively  occupational  diseases  the  physician  must  probe 
for  causes  back  of  his  diagnosis  if  registration  is  to  realize  what  is 
needed. 

This   extra-professional   information  which   the  physician   must 


Compulsory  Reporting  by  Physicians  267 

be  asked  for,  in  order  that  the  identity  of  the  disease  as  occupational 
in  character  may  be  evident,  at  least  presumably,  comprises  two 
items.  First,  and  rather  obviously,  but  none  the  less  of  most  im- 
portance, is  a  careful  statement  of  the  patient's  occupation  and  the 
industry  in  which  it  is  pursued.  Upon  this,  of  course,  all  accurate 
statistical  study  of  the  whole  subject  depends.  It  is,  likewise,  the 
first  necessary  inquiry  of  the  physician  in  determining  the  occupa- 
tional character  of  the  disease.  Had  the  physician,  in  the  case  of 
wood-alcohol  poisoning  above  referred  to,  looked  at  once  for  this 
item,  which  he  accidently  noticed  later,  doubtless  his  first  certificate 
of  the  cause  of  death  would  not  have  gone  so  wide  of  the  mark. 

But,  as  already  noted,  comparatively  few  industrial  diseases  are 
caused  exclusively  by  occupation.  Many  may,  or  may  not,  be 
occupational  in  character.  Furthermore,  even  in  the  case  of  an 
exclusively  occupational  disease,  other  factors  may  also  be  present. 
Hence,  in  the  second  place,  if  we  are  to  read  correctly  the  responsi- 
bility of  circumstances  of  occupation  for  disease,  the  physician  must 
be  asked  to  look  for  the  other  possible  causes,  and  to  report  any 
factors  other  than  occupation,  such  as  complicating  diseases  or 
personal  circumstances,  which  may  be  contributing  or  accompanying 
causes. 

Now  it  is  precisely  in  connection  with  this  extra-professional 
information  that  the  principal  difficulties  arise  with  physicians' 
reports, — that  is,  of  course,  after  the  primary  task  of  bringing  and 
keeping  before  physicians  the  necessity  of  reporting  at  all  is  accom- 
plished. The  reasons  for  this  are  natural  enough,  since  all  the  neces- 
sary information  as  to  occupational  or  other  causes  lies  beyond  the 
strictly  professional  interest  and  point  of  view  of  the  average  physi- 
cian, and  he  must  secure  it  by  special  inquiry  outside  of  his  purely 
technical  duties.  For  example,  when  the  New  York  law  requires 
that  all  cases  of  occupational  lead  poisoning  shall  be  reported,  it 
means  that  every  physician  who  may  treat  a  case  of  the  disease, 
after  his  professional  work  of  diagnosis  and  prescription  is  attended 
to,  must  first  of  all  remember  that  lead  poisoning  is  to  be  reported, 
and  that  then  he  must  make  inquiry  as  to  the  patient's  occupation, 
must  ascertain  whether  any  other  factors  enter  into  the  case  as 
causes,  and  must  record  this  information  with  the  necessary  details, 
along  with  a  number  of  other  items  as  to  sex,  age,  etc.,  all  outside  of 
his  natural  professional  interest  except  as  general  obligation  toward 
the  public  welfare  may  appeal  to  hirn. 


268  American  Labor  Legislation  Review 

To  a  large  extent  the  difficulties  referred  to  are  those  long 
familiar  in  connection  with  the  registration  of  deaths  by  physi- 
cians, and  simply  argue  that  without  doubt  a  long  period  of  educa- 
tion will  be  necessary  to  secure  general  and  accurate  observance  of 
a  reporting  law  for  industrial  diseases.  Indeed,  so  far  as  the  report 
of  diagnosis  and  the  statement  of  occupation  alone  are  concerned, 
the  problem  is  precisely  the  same  in  both  forms  of  registration. 
But  when  we  come  to  that  element  in  the  reporting  of  diseases 
which  virtually  requires  the  physician  specially  to  weigh  the 
causative  influence  of  occupation,  as  compared  with  other  possible 
causes,  there  is  a  fundamental  difference  between  the  two.  Regis- 
tration of  deaths  requires  a  statement  of  occupation  only  as  a 
simple  addendum  to  diagnosis,  and  requires  no  consideration  what- 
ever of  occupation  as  the  cause  of  death.  But  such  consideration 
is  essential,  as  pointed  out  above,  in  the  registration  of  industrial 
diseases.  It  is  specifically  implied,  moreover,  by  the  very  terms  of 
the  New  York  reporting  law  which,  like  all  but  one  of  those  in 
other  states  having  such  a  law,  follows  the  British  act,  and  which 
requires  a  report  from  the  physician  for  each  patient  "whom  he 
believes  to  be  suffering  from  (the  specified  diseases)  contracted  as 
the  result  of  the  nature  of  the  patient's  employment." 

The  most  significant  aspect  of  this  peculiar  source  of  difficulty 
connected  with  the  reporting  of  industrial  diseases  is  that  it  in- 
creases in  importance  as  compulsory  reporting  may  be  extended 
from  diseases  known  to  be  exclusively  or  mainly  occupational  to 
those  whose  sources  may  be  either  in  occupation  or  in  other  circum- 
stances, or  in  both  combined.  For,  as  we  proceed  in  this  direction, 
the  causes  of  the  disease  become  more  and  more  uncertain  and  com- 
plex, with  consequently  increased  difficulty  for  the  physician  who 
is  called  upon  to  determine,  or  at  least  to  express  his  belief  as  to, 
the  influence  of  occupation.  Compare,  for  example,  caisson 
disease  and  tuberculosis  as  to  the  relative  difficulty  of  determining 
whether  occupation  or  other  factors  were  responsible  for  the 
disease. 

This  aspect  of  the  reporting  problem  naturally  suggests  the 
question  of  how  general  the  reporting  should  be  made.  As  a 
matter  of  fact,  reporting  laws  enacted  in  this  country  so  far,  here 
again  in  accordance  with  the  British  act,  have  limited  compulsory 
reporting  to  a  small  number  of  easily  identifiable  industrial  dis- 


Compulsory  Reporting  by  Physicians  269 

eases,  namely,  as  in  the  New  York  law,  poisoning  by  lead,  phos- 
phorus, arsenic  or  mercury  or  their  compounds,  anthrax,  and  com- 
pressed-air illness.  All  of  the  American  laws  are  of  very  recent 
date  and  the  wisdom,  at  the  outset,  of  such  limitation  of  reporting 
would  seem  to  be  clear  from  what  has  here  been  said.  Neverthe- 
less, if  the  problem  of  industrial  diseases  is  to  be  treated  broadly, 
and  if  the  prevention  campaign  is  to  be  planned  on  comprehensive 
lines,  nothing  less  than  an  extension  of  registration  to  all  recogniz- 
able industrial  diseases  must  be  considered  as  the  ultimate  goal. 

This  may  appear,  at  first  sight,  to  be  only  an  ideal  whose  con- 
sideration may  well  be  postponed  for  the  present.  But  a  rather 
interesting  experience  in  New  York  State  has  brought  it  forward 
for  immediate  consideration.  The  New  York  reporting  law  took 
effect  in  September  of  last  year.  Prior  to  that  time  notices  of  the 
law  were  sent  to  medical  journals,  and  shortly  thereafter  a  circular 
notice  and  sample  forms  for  reports  were  mailed  to  each  of  the 
13,700  physicians,  hospitals,  and  dispensaries  in  the  state.  The 
form  adopted  for  reports  was  patterned  after  that  used  in  Great 
Britain,  was  kept  as  simple  as  possible,  and  was  limited  to  the  few 
items  specifically  mentioned  in  the  law,  without  taking  advantage  of 
a  blanket  clause  permitting  the  inclusion  of  other  items  of  informa- 
tion. The  form  was  made  thus  simple  with  the  express  idea  of 
encouraging  reporting  by  making  it  as  easy  for  the  physician  as 
possible.  (It  may  be  remarked,  parenthetically,  that  the  nine  months' 
experience  so  far  makes  it  very  evident  that  something  besides 
making  it  easy  will  be  required  to  make  reporting  general,  even  with 
a  very  limited  list  of  diseases).  But  the  law  had  not  been  in  force 
three  months  before  we  were  met  by  the  suggestion,  from  members 
of  the  medical  profession  itself,  that  we  were  not  calling  for 
enough  information  in  our  report  form  and  that  reporting  ought 
not  to  be  confined  to  the  diseases  mentioned  in  the  act,  some  of 
which  were  not  so  common  or  serious  as  others  not  included.  This 
was,  indeed,  far  from  being  a  general  clamor  from  the  profession 
as  a  whole,  but  it  was  an  earnest  expression  of  opinion  from  a  few 
prominent  members  in  New  York  City,  who  are  interested  in  the 
subject. 

The  question  of  the  extension  of  reporting  to  all  industrial  diseases 
thus  raised,  it  must  be  confessed,  in  an  unexpected  quarter,  but  in 
the  very  one  to  make  it  the  more  to  be  regarded,  became  then  an 


270  American  Labor  Legislation  Review 

immediately  practical  one  in  New  York.  To  come  at  once  to  the 
result  of  the  matter,  the  New  York  Department  of  Labor  proposes 
to  ask  the  cooperation  of  physicians  to  the  extent  of  reporting  all 
industrial  diseases,  and  is  just  completing  the  work  of  inaugurating 
such  extension.  The  reporting  law  has  not  been  amended  for  this 
purpose,  but  it  is  proposed,  for  the  field  outside  of  that  specified  in 
the  law,  to  rely  for  the  present,  at  least,  upon  the  voluntary 
cooperation  of  physicians. 

While  New  York,  relying  upon  a  cue  from  members  of  the 
medical  profession  itself,  thus  proposes  to  start  at  once  definitely 
toward  the  ultimate  goal,  it  will  be  evident  from  what  has  been  said 
in  this  paper  that  the  difficulties  of  this  larger  program  cannot  be 
overlooked,  and  a  word  or  two  as  to  practical  means  of  meeting 
these  difficulties  is  in  order. 

Government  offices  to  which  reports  are  to  be  made  have  two 
chief  means  of  overcoming  the  difficulties  referred  to.  The  first  of 
these  is  a  carefully  prepared  form  for  reports,  which  shall  clearly 
indicate  the  information  needed.  For  this  there  may  be  commended 
one  worked  out  by  the  committee  on  industrial  diseases  of  the  New 
York  Association  for  Labor  Legislation,  and  recently  adopted  with 
some  modification  by  the  New  York  Department  of  Labor  in  con- 
nection with  the  extension  of  reporting  above  alluded  to.  This 
form  is  indorsed  by  the  committee  on  uniform  schedules  of  the 
national  Association  for  Labor  Legislation,  which  recommends  it 
as  a  standard  schedule  for  use  in  all  states.  But,  as  repeatedly 
suggested  in  the  foregoing  analysis  of  the  reporting  problem,  ulti- 
mate success  must  finally  rest  to  a  large  extent  upon  the  active 
interest  of  physicians.  A  second  aid  to  reporting,  therefore,  may  be 
found  in  the  circulation  among  physicians,  for  their  assistance  and 
to  stimulate  their  interest,  of  information  concerning  industrial 
diseases.  For  an  example  of  this,  reference  may  be  made  to  a  book- 
let recently  issued  by  the  New  York  department,  containing  brief 
descriptive  matter  and  a  general  classification  of  industrial-disease 
hazards,  with  a  list  of  the  more  important  harmful  substances  and 
their  effect  upon  workers.  Reference  to  this  may  be  made  by  the 
writer  with  all  modesty  because,  for  the  material,  the  department  is 
largely  indebted  to  representatives  of  the  New  York  Academy  of 
Medicine,  especially  to  Dr.  W.  Oilman  Thompson  of  the  Cornell 
University  Medical  College. 


Compulsory  Reporting  by  Physicians  271 

In  the  foregoing,  compulsory  reporting  of  industrial  diseases  by 
physicians  has  been  considered  only  in  its  general  aspects  and 
chiefly  from  the  statistical  point  of  view.  From  that  point  of  view 
the  problem  of  accuracy  and  completeness  of  reporting  are  matters 
of  foremost  importance.  It  has  been  made  clear,  perhaps,  that  the 
solution  of  these  problems  will  be  a  matter  of  considerable  time  and 
education,  a  conclusion  which  is  supported,  not  only  by  analysis  of 
the  problems,  but  by  consideration  of  the  number  and  character  of 
the  reports  produced  by  nine  months'  experience  in  New  York. 
But,  lest  a  wrong  impression  as  to  the  value  of  reporting  should  be 
given  by  this  technical  view  of  the  matter,  two  practical  results, 
already  clear  in  New  York  experience,  may  be  mentioned  in  con- 
clusion. 

In  the  first  place  may  be  noted  the  very  active  interest  among  a 
number  of  influential  members  of  the  medical  profession  which  the 
reporting  law  almost  immediately  aroused,  or  at  least  crystallized 
into  activity.  This  has  already  been  alluded  to  in  connection  with 
the  assistance  it  has  lent  the  department  of  labor  with  reference 
to  reporting.  The  most  significant  fruit  of  it,  however,  has  been  the 
formation  of  a  permanent  committee  on  industrial  diseases  under 
the  auspices  of  the  New  York  branch  of  the  Association  for  Labor 
Legislation,  six  members  of  which  committee  are  physicians  con- 
nected with  medical  colleges  and  leading  hospitals  in  New  York 
City.  The  value  of  such  active  cooperation  of  the  medical  pro- 
fession in  the  campaign  for  industrial  hygiene,  going  far  beyond 
mere  reporting  of  diseases,  can  hardly,  of  course,  be  overestimated. 
If  the  reporting  laws  of  the  seven  other  states  in  which  such  laws 
have  been  enacted,  have  revealed  possibilities  of  this  kind  such  as 
have  appeared  in  New  York  within  the  first  few  months  under  its 
law,  the  work  of  the  American  Association  for  Labor  Legislation, 
in  securing  the  enactment  of  these  laws  during  1911  and  1912,  must 
be  regarded  as  marking  the  beginning  of  a  very  important  forward 
movement. 

In  the  second  place  is  to  be  noted  the  practical  value  of  reports 
of  industrial  diseases  as  indices  of  points  of  danger,  for  the  guid- 
ance of  factory  or  medical  inspectors.  This  is  a  value  which  may 
be  realized  practically  from  the  very  moment  that  reports  begin  to 
come  in,  without  regard  to  the  statistical  problems  of  reporting. 
Each  individual  report  at  once  invites  attention  to  an  establish- 


272  American  Labor  Legislation  Review 

ment  or  an  industry  for  investigation  with  a  view  to  preventive 
measures,  and  as  reports  multiply  the  field  demanding  attention 
becomes  more  and  more  clearly  indicated  for  the  inspector.  To 
illustrate,  the  medical  inspector  of  factories  in  New  York  State  is 
just  beginning  a  special  investigation  of  lead  poisoning.  As  a 
result  of  only  six  months'  returns  under  the  reporting  law,  the 
medical  inspector  may  begin  his  work  with  definite  knowledge  at 
the  very  outset  of  fourteen  different  manufacturing  industries  and 
of  one  or  more  particular  establishments  in  each  of  those  industries, 
in  which  conditions  positively  known  to  have  caused  lead  poisoning 
are  offered  for  immediate  application,  or  study,  of  preventive 
measures.  Here  again,  therefore,  the  enactment  of  reporting  laws 
in  eight  states  must  be  regarded  as  marking  a  very  important  step 
forward  in  the  practical  preventive  work  of  the  factory  and  medical 
inspector,  and  prevention  is,  of  course,  the  ultimate  goal  in  the 
whole  matter. 


Hi 


MAKING  LEAD  COLORS 

POURING   PIGMENTS  INTO  GRINDING  MACHINE  AND  SPRINKLING  COLOR  SOLU- 
TION WITH  LEAD  LITHARGE 


LEAD  CASTING,  SHOWING  LEAD  POT  IN  A  SMELTEK 

DANGER  OF  POISONING  is  FROM   BREATHING  LEAD  OXIDE,  FUMES  AND  DUST. 

THE  WORKER  IN  THIS  PICTURE  Now  LOSES  ON  AN  AVERAGE  ONE 

DAY  A  WEEK  ON  ACCOUNT  OF  CHRONIC  LEAD  POISONING 


LEAD  POISONING  IN  NEW  YORK  CITY] 


EDWARD  EWING  PRATT 
New   York  State  Factory  Investigating  Commission. 


It  has  often  been  said  that,  compared  with  foreign  countries, 
there  has  been  and  is  very  little  lead  poisoning  in  the  United  States. 
Recent  investigations,  however,  throw  considerable  doubt  upon 
these  conclusions.  The  Illinois  commission,  during  the  years  1908, 
1909,  and  1910,  found  five  hundred  and  seventy-eight  cases  of 
lead  poisoning  in  that  state  alone.  Last  fall  a  hasty  study  of  lead 
poisoning  in  New  York  City  revealed  three  hundred  and  seventy- 
six  cases  which  had  occurred  during  the  years  1909,  1910,  and  1911. 
And  during  the  year  1911  alone  there  were  found  one  hundred  and 
twenty-one  cases.  This  study  was  based  largely  upon  hospital 
records,  and  therefore  includes  only  the  more  serious  cases;  a  vast 
number  of  less  serious  ones  must  have  been  treated  in  dispensaries 
and  by  private  physicians.  These  facts  are  startling  when  we 
think  that  in  England  during  1910  there  were  only  five  hundred  and 
five  cases.  In  a  single  year  New  York  City  had  one  hundred  and 
twenty-one  cases, — all  England  five  hundred  and  five. 

CrheXe  cases  of  lead  poisoning  were  not  confined  to  any  one  trade 
or  industry,  but  were  scattered  through  a  considerable  number.  The 
industries  represented,'  in  which  the  victims  had  been  employed, 
were  the  following;  white-lead,  lead-acetate,  lead-oxid,  dry  colors, 
use  of  lead  as  a  hardening  agent,  scaling  paint  on  battleships,  ship- 
calking,  diamond-polishing,  printing,  carpentering,  plumbing,  tin- 
smithing,  and  painting. 

A  canvass  of  the  hospitals  in  Nlew  York  City  was  made,  and  all  the 
cases  of  lead  poisoning  or  plumbism  which  they  had  treated  during 
the  last  three  years  were  selected.  Names  and  addresses  of  the  per- 
sons and  any  other  available  facts  were  taken  from  the  hospital  rec- 
ords. These  records  were  lamentably  lacking  in  everything  that 

*The  facts  given  herewith  are  taken  from  a  study  made  last  fall  and  win- 
ter, by  the  writer,  with  the  cooperation  of  a  number  of  his  students,  and 
submitted  to  the  N.  Y.  State  Factory  Investigating  Commission. 


274  American  Labor  Legislation  Review 

would  interest  anyone  who  wished  to  make  a  study  of  lead  poison- 
ing and  its  causes.  In  only  two  hospitals  in  Greater  New  York  were 
occupations  specified  more  accurately  than  "laborer",  or  "painter", 
and  in  these  two  exceptional  instances  the  information  was  not  more 
detailed  than  the  statement,  "lead  worker",  "molder",  "carriage 
painter",  etc.  No  hospital  recorded  where  the  victims  had  worked, 
or  under  what  conditions.  However,  with  these  names  and  addres- 
ses, and  a  few  which  were  furnished  by  the  New  York  State  Depart- 
ment of  Labor,  the  labor  unions,  the  board  of  health,  and  several 
employers,  the  men  themselves  who  had  been  leaded  were  visited. 

It  was  not  always  easy  to  find  the  people  we  wanted,  for,  in  addi- 
tion to  the  difficulties  due  to  false  addresses,  which  are  habitually 
given  at  hospitals,  we  found  it  difficult  to  locate  Poles,  Slavs,  Rus- 
sians, Lithuanians,  Italians,  and  others  of  our  recent  immigrants. 
I  remember  searching  for  a  man  named  John  Sichosk,  whose  name 
had  been  sent  in  by  the  department  of  labor.  At  the  address  given, 
only  the  blankest  faces  answered  my  inquiry  for  John  Sichosk.  In 
broken  English  one  of  the  men  explained  that  he  knew  no  one  by 
that  name.  As  a  last  resort  I  showed  the  record  card  with  the 
typewritten  name.  The  man's  face  lighted  up  at  once,  "Oh!  John 
Sichosky !  Sure,  he  live  upstairs."  He  was  there  all  right,  and 
before  the  afternoon  was  over  John  had  taken  me  to  five  others 
who  had  been  leaded  in  the  same  factory. 

A  careful  study  was  made  of  each  case.  The  facts,  not  only 
about  the  man's  last  job,  but  concerning  others  as  far  back  as  he 
could  remember,  were  ascertained.  As  far  as  possible  the  maternal 
history  of  the  wife  was  obtained,  the  personal  habits  of  the  work- 
er, and  the  precautions  or  lack  of  precautions  in  the  factory.  One 
hundred  and  nine  cases,  in  all,  were  intensively  studied  in  this  way. 
The  results  are  interesting,  even  if  the  small  number  of  cases  some- 
what detracts  from  their  value.  In  general,  these  results  are  similar 
to  the  results  of  studies  made  abroad. 

Practically  all  the  various  forms  of  lead  poisoning  were  found, 
ranging  from  light  attacks  of  colic  to  death.  Among  these  cases 
were  several  of  wrist-drop  and  paralysis.  Many  of  the  workers 
had  had  recurring  attacks  and  had  been  disabled  for  considerable 
periods,  varying  from  a  few  days  to  almost  a  year.  About  half  of 
the  men  were  comparatively  young;  in  fact,  fifty  of  the  one  hun- 
dred and  nine  were  actually  less  than  thirty-five  years  of  age,  and 


Lead  Poisoning  in  New  York  City  275 

almost  one  hundred  were  less  than  fifty-five  years  of  age  when  they 
became  leaded. 

Economists  of  the  old  school  have  always  held  that  men's  wages 
increase  with  the  dangers  and  risks  of  their  employment.  This  is 
certainly  not  true  of  lead  workers.  Over  half  of  the  workers 
studied  (fifty-eight)  were  earning  less  than  $16.00  per  week;  a  quar- 
ter (twenty-three)  were  earning  less  than  $12.00;  and  over  a  tenth 
(thirteen)  were  actually  earning  less  than  $10.00.  Strangely 
enough,  the  most  dangerous  of  all  the  industries  paid  the  lowest 
wages.  In  the  white-lead  industry  not  a  single  man  was  earning 
over  $14.00  per  week,  and  many  of  them  were  earning  less  than 
$10.00.  At  these  low  rates  one  would  imagine  that  the  total  loss 
of  wages  due  to  lead  poisoning  would  be  comparatively  small.  It 
is  not  surprising,  therefore,  that  most  of  the  losses  were  of  small 
amounts,  and  that  fifty-nine  of  the  one  hundred  and  nine  men  lost 
less  than  $150  each.  But  it  is  a  surprising  fact  that  some  of  these 
workers  lost  larger  sums,  seven  men  actually  losing  over  $1,000 
each. 

Some  very  interesting  facts  were  brought  out  in  the  analysis  of 
conditions  in  the  factories  and  workshops.  Sixty-two  of  the  one 
hundred  and  nine  workers  ate  in  the  same  room  where  they  worked ; 
twenty-two  never  washed  before  eating  and  forty-five  washed  only  in 
cold  water ;  seventy-three,  or  almost  three-fourths,  were  never  given 
oral  instructions  of  any  kind  as  to  the  dangers  of  their  work  or  as  to 
methods  of  preventing  lead  poisoning;  seventy-six  men  never  saw 
any  posted  instructions  where  they  worked.  It  is  usually  admitted 
that  men  addicted  to  alcohol  are  more  liable  to  contract  lead  poison- 
ing, as  they  are  to  succumb  to  most  other  diseases.  Employers 
delight  to  say  that  it  is  only  the  "hard  drinkers"  who  are  ever 
troubled  by  lead.  But  only  six  of  the  one  hundred  and  nine  men 
were  found  to  use  alcohol  to  excess ;  sixty-five  were  moderate  drink- 
ers; and  thirtyrone  were  teetotalers.  These  facts  point  out  and 
emphasize  the  importance  of  the  problem,  right  here  and  now  in 
this  country,  and  the  need  of  prevention,  the  first  steps  in  which 
have  evidently  not  been  taken  by  the  majority  of  employers. 

Of  the  one  hundred  and  nine  cases  studied,  seventy-nine  persons 
were  married,  among  them  forty  men  whose  wives  had  been  preg- 
nant while  their  husbands  were  employed  at  lead  work.  In  all  there 
had  been  one  hundred  and  fifty-seven  conceptions  among  these  forty 


276  American  Labor  Legislation  Review 

wives.  There  were  born  to  the  persons  one  hundred  and  forty-four 
children,  thirty-nine  of  whom  died  in  the  first  year,  and  two  in  the 
second.  The  cause  of  death  in  many  cases  was  malnutrition  and 
convulsions.  In  addition,  there  were  four  still-births  and  eight 
miscarriages ;  and  the  latter  figures  understate  the  facts,  as  our  in- 
formation on  this  point  is  not  full  nor  very  accurate. 

The  effect  upon  reproduction  has  long  been  noted.  Some  in- 
teresting cases  have  come  to  my  attention : 

1.  A  young  Hungarian  came  to  this  country  in  1904.     He  worked  in  a 
wire  mill,  where  the  wire  is  tempered  and  hardened  by  being  passed  through 
a  bath  of  molten  lead.     The  lead  is  uncovered,  and  vapors  and  oxids  fill 
the  air.     He  married  in  1909.     In  the  same  year  his  wife  miscarried  at  the 
end  of  seven  months.    Early  in  1910  a  second  child  was  born  but  died  of  con- 
vulsions within  two  weeks.     About  this  time  the  husband  had  a  severe  at- 
tack of  lead  poisoning  and  was  given  another  job.     In  January  of  this  year 
the  wife  gave  birth  at  full  term  to  a  normal  child. 

2.  A   Barbadoes   negro   came   to   the   United    States   in    1908.     He   was 
married  and  had  a  little  daughter,  at  that  time  two  years  of  age.     He  found 
work  in  a  lead  factory  handling  and  packing  sugar  of  lead,  or  lead  acetate. 
The  following  year  his  wife  miscarried  at  the  end  of  seven  months.     A  year 
later  a  child  was  born  at  full  term,  but  died  in  convulsions  when  six  months 
old.    The  curious  part  of  this  case  is  that  the  worker  himself  was  unaffected 
until  a  few  months  ago  and  until  after  the  birth  last  referred  to. 

3.  James  Scott  was  a  printer  for  over  forty  years  and  died  of  lead  poison- 
ing.   He  was  married  in  1868.    Of  twelve  births  six  children  survived,  four 
died   from  various  causes  during  their  first  year,  there  was  one  still-birth 
and  one  miscarriage. 

4.  Alexander  Joronsky,  a  Pole,  came  to  this  country  in  1891.    After  hav- 
ing various   unskilled   jobs,   he   found   employment  as   a   stripper   in   a   big 
white-lead  factory.     During  his  period  of  employment  as  a  stripper  his  wife 
gave  birth  to  four  children;  one  of  these  was  still-born,  and  the  others  lived 
four  days,  three  days,  and  one  day  respectively. 

5.  A  Hungarian  painter,  who  came  to  this  country  in   1893,  presents  an 
interesting  case.     Five  of  his  ten  children  died  within  a  year  of  their  birth 
and  his  wife  has  had  two  miscarriages.    The  man  himself,  however,  had  his 
first  attack  very  recently. 

The  investigation  of  hospital  cases  at  once  opened  up  numerous 
others,  and  also  gave  us  clues  to  factories  where  there  were  lead 
processes  of  which  we  did  not  know.  The  next  step  in  the  investi- 
gation, therefore,  was  the  inspection  of  factories. 

One  of  the  first  cases  which  came  to  our  attention  was  a  pathetic 
case  of  double  wrist-drop.  The  victim,  a  man  of  middle  age,  had 
worked  in  a  magneto  factory.  It  was  a  big  place,  with  many  hun- 


DUST  COLLECTORS  IX  A  LEAD  PLAXT 

CLOTH  BAGS  PERMIT  AIR  FROM  EXHAUSTS  TO  PASS  THROUGH  WHILE  RETAIN- 
ING LEAD  DUST  WHICH  FALLS  INTO  BINS  AND  is  SAVED.     IN  UP-TO- 
DATE  PLANTS  THE  BAGS  ARE  SHAKEN  BY  A  MECHANICAL 
DEVICE  OPERATED  FROM  OUTSIDE  OF  DUST  HOUSE 


EMPTYING   A    RED-LEAD    FURNACE 

WHEN   OXIDIZED   IN   FURNACES   THE   LEAD  is   RAKED   OUT  INTO   CARS.     IN 

SPITE  OF  POWERFUL  EXHAUSTS  AND  HOODS  SOME  DUST  FLOATS  IN  THE 

AIR  AND  is  BREATHED  BY  THE  WORKERS 


Lead  Poisoning  in  New  York  City  277 

dreds  of  employees,  but  the  lead  process  was  carried  on  exclusive- 
ly in  one  small  room,  a  sort  of  lean-to  at  the  rear  of  the  factory 
and  a  little  below  the  level  of  the  ground.  Here  were  located  five 
lead  pots,  the  temperature  of  which  varied  from  800  to  150x3  de- 
grees. These  pots,  when  inspected,  were  covered  by  hoods 
leading  to  a  chimney,  but  were  not  provided  with  any  blower  at- 
tachment. The  roof  was  raised  slightly  and  a  fan  at  one  end  gave 
a  fairly  good  air  circulation.  In  the  process  preceding  the  so-called 
"hardening",  bars  of  steel  are  bent  into  the  horseshoe  shape  of  a 
magnet.  They  are  then  brought  into  the  hardening  room  and  im- 
mersed in  a  bath  of  molten  lead.  There  they  remain  for  a  specified 
length  of  time,  when  they  are  removed  and  suddenly  immersed  in 
water.  After  cooling  they  are  stacked  up,  one  above  the 
other,  and  are  rubbed  down  with  sandpaper  to  remove  any  particles 
of  lead  that  remain.  This  process,  at  the  time  when  the  inspection 
was  made,  had  been  in  operation  for  less  than  a  year  and  nine  men 
were  employed  at  it.  I  found  seven  cases  of  lead  poisoning;  one 
had  resulted  in  death,  and  one  in  double  wrist-drop;  others  had 
necessitated  long  periods  of  unemployment. 

A  wire  mill  carried  on  a  similar  process.  Here  the  tempering 
and  hardening  is  done  by  passing  the  wire  slowly  through  a  bath 
of  molten  lead.  The  wire  is  wound  on  huge  spools  revolving  slowly, 
and  is  then  wound  onto  another  reel.  The  room  is  habitually  full 
of  smoke,  gas,  and  fumes,  and  the  men  work  intolerable  hours, — 
two  shifts  of  twelve  hours  each,  with  no  time  for  meals.  They  have 
to  snatch  what  they  eat, — because  the  lead  positively  cannot  be 
cooled  off. 

In  both  of  these  processes  the  danger  comes,  I  believe,  not  from 
the  fumes  of  molten  lead,  but  rather  from  the  particles  of  lead  oxid 
which  probably  fill  the  air.  In  both  cases  the  skimmings  from  the 
lead  pots  are  brushed  carelessly  aside  and  allowed  to  fall  upon  the 
floor,  or  to  accumulate  in  piles  beside  the  pots. 

Some  of  you  will  wonder  how  a  girl  working  in  an  embroidery 
factory  can  be  poisoned  by  lead.  You  will  doubtless  scoff  at  the 
possibility  of  a  worker  on  embroidery  contracting  lead  poisoning. 
But  I  have  found  two  such  cases.  The  designs  to  be  embroider- 
ed are  stenciled  on  cloth.  This  is  usually  done  with  a  mixture  of 
chalk  and  talcum  powder.  One  resourceful  employer,  however,  ob- 
serving the  way  in  which  the  chalk  rubbed  off,  substituted  dry 


278  American  Labor  Legislation  Review 

white  lead,  which  clings  more  tenaciously.  The  girls  who  used  it 
were  ignorant  of  its  poisonous  character  and  handled  it  as  care- 
lessly as  they  had  handled  the  chalk.  They  pounded  it  into  the 
stencils  and  the  dust  rose  in  their  faces  and  the  lead  covered  their 
hands.  Little  wonder  they  got  lead  poisoning.  The  use  of  lead  for 
this  purpose  is  common. 

Another  case,  which  is  individually  the  most  pathetic  I  have  seen, 
is  that  of  William  O'Connell.  O'Connell  has  now  been  out  of 
work  for  about  eleven  months  and  is  likely  to  remain  so,  as  he  is  to- 
tally incapacitated.  The  interesting  and  exasperating  thing  about  it  is 
that  he  is  our  employee, — speaking  collectively, — because  O'Con- 
nell was  in  the  employ  of  the  United  States  government,  immediate- 
ly under  the  Navy  Department  and  a  worker  in  the  Brooklyn  Navy 
Yard,  where  his  job  was  that  of  "scaling"  in  the  double  bottoms. 
Battleships  are  provided  nowadays  with  double  bottoms,  a  shell 
which  envelops  the  entire  keel  of  the  ship ;  between  these 
bottoms  is  a  space  of  about  two  and  one-half  feet,  which  is  divided 
into  compartments  of  from  four  to  six  feet  square.  In  order  to 
prevent  rust  these  double  bottoms  are  painted  with  red  oxid  of 
lead,  sometimes  to  a  thickness  of  one-fourth  of  an  inch.  The  pro- 
cess of  scaling  consists  of  scraping  off  the  red  oxid  paint  with  an 
automatic  compressed-air  chisel  called  a  "hammer".  When  in  op- 
eration this  hammer  throws  a  spurt  of  dust  up  into  the  faces  of  the 
workmen,  who  wear  goggles  but  no  respirators.  Sometimes  several 
men  work  in  one  small  compartment,  and  they  tell  me  that  it  is  al- 
most impossible  to  see  the  electric  bulbs  at  their  elbows.  "And 
then  when  the  air  hose  breaks,  you  ought  to  see  the  place !"  one  of 
the  men  remarked.  Think  of  working  in  such  a  place  for  eight 
hours  a  day !  It  is  any  wonder  that,  out  of  a  squad  which  averaged 
about  fifty  men,  we  found  twenty  cases  of  severe  lead  poisoning,  in- 
cluding two  deaths  and  O'Connell,  who  is  totally  incapacitated? 
And  these  men  have  no  washing  facilities,  they  wear  no  respirators, 
there  is  no  exhaust,  there  are  no  accessible  eating  facilities,  there  is  no 
medical  inspection,  and  they  get  no  compensation.  The  government 
gives  no  compensation  for  lead  poisoning  because,  technically,  it 
is  not  an  accident, — which  is  true,  for  under  the  circumstances  it 
is  a  dead  certainty.  Yet  the  surgeon  of  the  post  asked  me, — a  lay- 
man,— "Why !  is  that  work  dangerous  ?" 

Other  industries  contributed  their  quotas  of  lead  poisoning  cases. 


Lead  Poisoning  in  New  York  City  279 

One  firm,  manufacturing  white  and  red  lead,  reported  through  its 
physicians  twenty-four  cases  from  October,  1910,  to  October,  1911. 
We  dug  around  a  bit  and  found  a  dozen  more.  About  two  hundred 
men  were  exposed.  In  another  white-lead  works,  where  the  factory 
had  been  running  with  about  two  dozen  men,  we  found  eight  cases 
diagnosed  by  the  factory  physician.  In  another  white-lead  fac- 
tory the  superintendent  claimed  that  no  case  of  lead  poisoning 
had  ever  occurred  during  his  ten  or  a  dozen  years  there;  for,  said 
he,  "We  send  a  man  off  when  he  shows  the  first  signs  of  being 
leaded."  The  next  Sunday  I  saw  five  men  who  had  been  leaded  in 
that  plant,  and  who  had  been  out  of  work  for  periods  varying  from 
a  week  to  almost  a  year.  One  poor  fellow  had  had  four  separate 
attacks  and  had  gone  doggedly  back  to  the  same  job.  Just  the 
week  before,  when  he  was  suffering  severely  from  colic,  this  same 
superintendent  had  on  two  occasions  sent  a  messenger  to  him  asking 
him  to  come  back  to  work. 

Of  all  the  industries  which  I  have  studied,  painting,  especially 
interior  decorating,  yields  more  lead  poisoning  than  any  other,  not 
proportionately  but  in  the  total  number  of  victims.  Man  after  man 
had  the  same  tale  to  tell, — a  long  job,  close  interior  work,  sand- 
papering, stipple,  painting,  more  sandpapering  and  more  painting,  a 
sudden  overpowering  attack,  and  a  period  of  sickness  and  idleness, 
leaving  him  just  at  the  end  of  the  busy  season  when  it  is  impossible 
to  find  work. 

It  does  not  occur  to  many  of  us  that  in  New  York,  at  any  rate,  a 
building  in  course  of  construction  is  absolutely  (with  one  or  two 
possible  exceptions)  without  the  pale  of  the  law.  And  yet  any  new 
building  in  course  of  construction  in  New  York  City  has  constantly 
working  in  it  from  two  hundred  to  six  hundred,  or  even  more,  men. 
These  men  are  usually  working  under  almost  intolerable  conditions, 
with  a  complete  lack  of  sanitary  conveniences,  no  washing  facilities, 
no  provision  for  eating,  and  no  attention  to  health  or  hygiene. 
Many  a  painter  has  related  to  me  how  impossible  it  is  for  him  to 
wash  his  hands  for  lunch,  and  how  he  is  forced  to  hold  his  sand- 
wich between  two  pieces  of  paper  in  order  to  keep  his  lead-covered 
hands  from  coming  in  contact  with  his  food.  It  is  not  a  difficult 
matter  for  a  builder  to  safeguard  his  painters.  He  can  use  zinc  white, 
which  is  better  in  some  ways  than  white  lead  and  is  but  slightly  more 
expensive.  In  fact,  one  of  the  biggest  so-called  speculative  builders 
in  New  York  City  now  specifies  white  zinc  and  wet  sandpapering. 


280  American  Labor  Legislation  Review 

We  have  now  acquired  in  this  country,  I  believe,  a  body  of  evi- 
dence which  demonstrates  the  prevalence  of  lead  poisoning  and 
other  industrial  diseases.  They  may  not  be  as  prevalent  as  abroad, 
but  I  doubt  it.  The  industries  in  which  these  diseases  are  found 
employ  unskilled,  non-English  speaking  workers,  who  pass  quickly 
from  one  industry  to  another,  and  who  seldom  come  under  the  ob- 
servation of  the  authorities. 

In  preventing  industrial  disease,  especially  lead  poisoning,  an  ed- 
ucational campaign  is,  it  seems  to  me,  the  thing  of  prime  impor- 
tance,— education  of  the  worker  and  education  of  the  employer. 
The  first  step  in  the  education  of  the  employee  is  a  knowledge  of 
the  rudiments  of  English,  then  the  simple  rules  for  the  care  of 
health  and  self  which  are  so  effective  in  preventing  lead  poisoning. 
The  employer,  on  the  other  hand,  should  be  told  that  there  is  such 
a  thing  as  lead  poisoning,  and  then  how  to  prevent  it  and  how  to 
treat  it.  There  are  many  employers  who  are  willing  and  anxious  to 
safeguard  their  workers.  One  white-lead  manufacturer  is  spending 
$20,000  on  prevention.  He  may  not  be  doing  it  in  the  right  way,  but 
he  has  got  the  right  spirit  and  will  doubtless  do  more, — more  in  fact 
than  he  could  be  forced  to  do.  Then,  let  us  bring  on  the  legislation 
and  force  the  recalcitrant  employers  into  line. 


GENERAL  DISCUSSION 


i.  LEAD  POISONING 

MR.  F.  V.  HAM  MAR,  President  of  Plammar  Brothers  White-Lead 
Co.,  East  St.  Louis,  Illinois:  I  think  the  pictures  shown  by  Mr. 
Pratt  demonstrate  one  fact,  and  that  is  that  all  lead  poisoning  comes 
from  lead  dust.  Factories  can  be  made  sanitary  by  the  elimination 
of  dust.  This  statement  relates,  not  to  industrial  poisoning  as  a 
whole,  but  to  white  lead,  and  is  based  on  experience  in  my  own  fac- 
tory. We  are  not  appalled  by  the  lead  menace.  Our  record  of 
twelve  years  is  not  one  death,  either  in  our  lead  smelter  or  in  our 
white-lead  works,  and  in  the  past  eleven  months  we  have  had  but 
four  reportable  cases  under  the  Illinois  law,  and  the  loss  of  labor 
was  not  to  exceed  fifteen  to  twenty  days.  The  experience  of  those 
who  have  been  reasonably  successful  in  controlling  lead  poisoning, 
with  a  view  to  minimizing  the  laborer's  loss  of  wages  and  preventing 
any  danger  to  his  future  health,  should  be  of  interest. 

No  consideration  of  the  sanitation  of  lead  works  is  valuable  until 
the  avenue  of  entrance  of  various  poisons,  dusts,  fumes,  or  gases 
into  the  human  body  is  satisfactorily  settled.  If  you  do  not  know 
how  toxins  get  into  the  body,  you  have  little  hope  of  knowing  how 
to  keep  them  out.  Lead  poisoning  seems  to  be  particularly  pro- 
ductive of  theories  as  to  causes  of  inoculation.  But,  as  a  practical 
fact,  lead  is  non-poisonous  until  brought  into  contact  with  the  fluids 
of  the  alimentary  tract,  chiefly  hydrochloric  acid  in  the  stomach. 
Undissolved  lead  is  no  menace,  and  only  when  dissolved  by  the  or- 
ganic fluids  is  it  absorbed  into  the  vascular  system.  Such  solvents 
are  lacking  in  all  organs  except  the  alimentary  tract.  Therefore 
the  skin,  abrasions  of  the  skin,  the  scalp,  under  the  finger  nails,  and 
even  the  lungs,  are  not  avenues  of  entrance  of  toxins.  If  they 
were,  they  have  little  if  any  power  of  converting  sufficient  lead  salt 
into  soluble  poisons  and  absorbable  solutions  to  be  a  serious  menace 
to  health.  There  is  no  doubt  but  that  mild  plumbism  may  result 
from  lead  hair  dyes  and  lead  face  powders,  and  that  lethal  quantities 
may  be  forced  into  the  pulmonary  organs  of  a  cat,  but  the  menace  of 


282  American  Labor  Legislation  Review 

such  special  conditions  is  so  rare  and  so  slight  that,  for  general  pur- 
poses of  sanitation,  we  may  assume  that  the  only  avenues  of  entrance 
are  the  nose  and  the  mouth,  and  that  the  only  place  of  conversion 
into  absorbable  liquids  is  the  alimentary  canal. 

The  cardinal  principle  of  lead-works  hygiene,  therefore,  is  to  pre- 
vent the  lead  salt,  in  any  form,  from  entering  the  nose  or  mouth.  The 
first  necessity  is  to  inform  all  workmen  of  the  danger  of  lead  poison- 
ing,— that  it  comes  from  working  in  lead  dusts ;  that  the  first  symp- 
toms of  intoxication  are  constipation  and  colic;  and,  of  great  im- 
portance, that  as  soon  as  they  notice  alimentary  disturbances,  they 
are  to  report  at  once  to  the  foreman  and  to  the  factory  physician 
for  treatment. 

That  men  may  work  in  a  minimum  of  dust,  forced  drafts,  hoods, 
and  artificial  ventilation  are  necessary.  It  is  generally  recommended 
by  authorities  that  floors  should  be  of  such  material  that  they  may 
be  flushed  daily,  and  this  is  most  desirable.  If  all  lead  works  could 
be  rebuilt,  for  this  and  other  economical  reasons,  they  would  have 
concrete  floors.  But  we  believe  forced  drafts  are  more  efficacious 
than  flushed  floors  because,  while  it  is  most  desirable  that  floors 
should  be  clean,  the  first  truck  or  barrel  that  passes  over  them  drops 
some  lead  salts,  and  the  quantity  on  the  previously  clean  floor  ac- 
cumulates in  proportion  to  the  work  done  during  the  day.  Lead 
salt  is,  as  a  rule,  of  high  specific  gravity  and  only  a  small  proportion 
of  the  siftings  are  carried  into  the  air.  As  a  result,  while  the  floors 
may  not  be  immaculate,  the  ventilators  soon  remove  floating  parti- 
cles, and  leave  the  air  cleaner  and  more  sanitary  than  where  the 
floors  are  flushed  daily  without  the  forced  draft  and  ventilation. 

There  is  no  doubt  in  our  minds  that  under  all  circumstances  and 
conditions,  no  matter  how  perfect  the  ventilation  and  cleanliness, 
wherever  lead  dust  is  in  the  air  the  workman  must  wear  a  protec- 
tion over  the  nose  and  mouth.  We  have  to  some  satisfactory  extent 
perfected  a  "mask"  that  is  inexpensive,  affords  a  maximum  area 
for  air  filtration,  and,  once  it  becomes  damp  from  the  laborer's 
breath,  is  an  excellent  protection  against  dust.  The  workmen  wear 
these  masks  without  objection,  and  the  results  are  very  encouraging. 
There  are  places  in  all  American  factories  where  fans,  drafts,  or 
flushed  floors  are  impossible.  In  these  departments  the  workmen  are 
forced  to  wear  masks,  the  circulation  of  air  is  as  free  as  possible, 
the  hours  of  labor  are  reduced  to  a  minimum,  and  the  physician 


General  Discussion  283 

gives  his  especial  attention  to  the  men  employed.  Our  records  show 
that,  by  these  means,  the  menace  is  reduced  to  a  minimum.  We  find 
it  essential  to  separate  the  dusty  departments  from  those  where  no 
dust  originates,  for  the  men  who  handle  lead  in  oil  never  suffer 
from  plumbism,  and  in  the  latter  department  the  liberal  use  of  ordi- 
nary floor  oil  is  quite  satisfactory.  It  fixes  in  place  such  dust  as  may 
blow  in  and  assists  in  sanitation. 

All  of  these  suggestions  are  only  coordinate  with  shower-baths, 
washing  facilities,  places  for  eating  outside  the  factory,  frequent 
sweeping,  and  above  all  constant  vigilance  to  see  that  the  laborer 
realizes  the  danger  and  uses  "the  precautions  furnished.  But  all 
these  items  are  precautionary.  The  active  and  effective  agency 
in  the  conservation  of  our  workmen's  health  is  an  excellent  phy- 
sician. No  system  of  prevention  can  be  devised  that  will  be  so 
perfect  as  entirely  to  prevent  plumbism  among  men  of  the  small 
intelligence  of  the  average  day-laborer.  The  tendency  is  always 
to  minimize  the  danger  and  to  disregard  positive  orders  regard- 
ing wearing  the  mask  and  proper  cleanliness  in  eating.  There- 
fore men  do  get  lead  colic,  and  they  often  neglect  to  report  it 
until  it  becomes  severe.  In  fact,  such  serious  cases  as  we  have  had 
have  almost  invariably  arisen  among  strong,  vigorous  young  white 
men  who,  in  the  egotistical  belief  that  nothing  can  hurt  them,  neg- 
lect, as  far  as  they  dare,  our  regulations  for  their  protection,  espe- 
cially in  emergencies.  That  we  may  treat  cases  in  their  incipiency, 
our  physician  personally  sees  all  the  workmen  every  Friday.  The 
men  whom  he  suspects  of  intoxication  are  held  for  personal  exami- 
nation. His  experience  enables  him  to  spot  a  suspect  at  sight  and  a 
few  words  completes  the  diagnosis.  There  is  a  great  advantage  in 
reaching  the  case  in  its  incipiency,  when  a  spoonful  of  Epsom  Salts 
will  effect  a  cure. 

There  is  no  doubt  that  white  lead  is  a  menace.  But  there  is  also 
no  doubt  that  this  menace  can  be  controlled.  For  such  control  regu- 
lation and  law  are  necessary.  We  believe  in  legislation  for  danger- 
ous trades.  The  necessity  for  it  comes,  however,  from  ignorance 
rather  than  from  essential  danger.  We  believe  that  every  man 
working  in  lead  should  realize  how  and  why  he  may  become  intoxi- 
cated and,  equally  important,  how  he  can  avoid  serious  results.  Legis- 
lation is  necessary  that  this  information  shall  be  disseminated;  and 
legislation  helps  the  manufacturer  by  assisting  him  to  enforce  regu- 


284  American  Labor  Legislation  Review 

lations.  That  plumbism  can  be  controlled  to  a  satisfactory  degree 
I  know  beyond  a  question  of  doubt,  and  if  your  Association  can 
suggest  any  practical  methods  or  regulations  that  will  assist  in  re- 
moving the  menace  to  labor,  all  white-lead  makers  will  give  you 
hearty  cooperation. 

DR.  JAMES  P.  WARBASSE,  New  York  City:  I  have  listened  with 
interest  to  this  apology  for  the  lead  industries.  But  I  think  there  is 
one  point  to  bring  out,  that  the  lead  industry  is  practised  for  the 
profit  there  is  in  it.  There  are  satisfactory  measures  for  protecting 
the  lead  worker,  but  I  do  not  agree  with  the  previous  speaker  that 
adequate  means  of  protection  are  now  used  in  any  factory  in  the 
United  States.  The  question  of  profit  is  the  important  side  and  it 
behooves  us,  as  students  of  industrial  diseases,  to  bear  this  fact 
in  mind. 

DR.  J.  W.  Foss,  Arizona:  The  statement  has  been  made  that  the 
only  way  a  person  can  become  poisoned  from  lead  is  through  the 
intestines,  and  not  through  the  skin.  Only  last  evening  Dr.  Ander- 
son of  the  Navy  told  me  they  had  been  making  investigations  of  the 
poisoning  of  the  men  who  chip  off  paint  scales  in  the  Brooklyn 
Navy  Yard.  They  made  tests  and  it  was  thoroughly  demonstrated 
that  in  seven  days  you  could  get  poisoning  by  rubbing  lead  on  the 
skin.  The  investigations  made  by  the  Navy  show  that  it  is  a  great 
error  to  believe  that  you  cannot  be  poisoned  except  through  the 
intestinal  tract,  and  that  we  ought  not  to  allow  this  idea  to  go  out. 

MR.  HAM  MAR:  The  men  who  work  in  the  Navy  wear  goggles 
instead  of  respirators.  I  contend,  very  reasonably,  that  if  they  keep 
the  dust  out  of  their  mouths  they  will  keep  it  out  of  their  systems. 
But  I  was  speaking  of  white-lead  works,  and  ninety  per  cent  of  lead 
poisoning  conies  from  sandpapering  and  not  from  lead  works. 

DR.  C.  T.  GRAHAM-ROGERS,  Medical  Inspector  of  Factories,  New 
York:  The  fact  that  lead  is  absorbed  through  the  skin  and  pro- 
duces toxic  effects  is  brought  out  by  Rambousek  of  Austria  and 
Roth  of  Germany,  in  works  published  within  a  year.  The  method 
of  poisoning  indicated  by  Mr.  Hammar  is  the  more  usual,  but  most 
of  the  cases  of  lead  poisoning  occur  among  painters  who  are  work- 


LEAD  USED  AS  A  HARDENING  AGENT 

STEEL    MAGNETS   ARE    DIPPED    INTO    MOLTEN    LEAD   UNTIL   RED    HOT,    THEN 

PLUNGED  INTO  WATER,  AND  WHEN  COOLED,  POLISHED  WITH  SAND 

PAPER.     WORKERS  ENDANGERED  B«Y  FUMES  AND  DUST 


HEADING  UP  BARRELS  OF  DRY  RED  LEAD 

DEATHS    DUE   TO   LEAD    POISONING    FROM    BREATHING    DUST   IN   THIS   WORK- 
HAVE  SOMETIMES  BEEN  REPORTED  BY  PHYSICIANS  WITH  THE  OCCUPA- 
TION GIVEN  MERELY  AS  "COOPER".     A  MORE  SPECIFIC  STATE- 
MENT  OF   OCCUPATION   is    NEEDED  TO   REVEAL   TRUE 
CAUSE  OF  DEATH 


General  Discussion  285 

ing  with  lead  paints.  When  they  are  employed  in  sandpapering 
paint  and  the  application  of  oil  is  neglected,  the  poison  is  absorbed 
through  the  skin. 

MR.  JOHN  VOGT,  New  York  Department  of  Labor:  I  had  the  good 
fortune  to  accompany  Mr.  Pratt  during  his  investigation,  and  from 
the  many. tests  I  made  of  the  various  oxids  came  to  the  conclusion 
that,  where  the  dust  was  eliminated  as  much  as  practicable,  the  num- 
ber of  cases  of  lead  poisoning  was  reduced. 

PROFESSOR  C.-E.  A.  WINSLQW,  New  York  City:  The  great  pos- 
sibility of  lead  poisoning  is  getting  lead  into  the  mouth.  It  is  an 
ordinary  problem  of  sanitation. 

DR.  HAROLD  K.  GIBSON,  Illinois  Factory  Inspection  Department: 
Mr.  Hammar's  remarks  are  interesting.  I  believe  he  is,  like  others, 
making  an  effort  to  eliminate  lead  poisoning  from  his  plant.  It 
can  be  eliminated,  but  all  the  dust  collectors  and  improved  methods 
of  sanitation  and  exhaust  devices  and  washing  facilities  will  not 
do  it  by  themselves.  After  all,  I  think  the  decisive  factors  are  strict 
personal  supervision  by  foremen  and  the  education  of  the  men  in 
personal  hygiene.  We  have  what  we  call  two  classes  of  manu- 
facturers, those  who  comply  with  the  letter  of  the  law  and  those 
who  comply  with  the  letter  and  with  the  spirit.  Mr.  Hamrnar  I 
know  to  be  one  of  the  latter  class.  All  these  measures,  including 
sanitation,  will  not  avail  unless  the  manufacturer  complies  with  the 
spirit  of  the  law. 

DR.  JOHN  B.  ANDREWS,  Secretary,  American  Association  for 
Labor  Legislation,  New  York  City:  A  year  and  a  half  ago  Mr. 
Hammar  treated  this  subject  at  our  annual  meeting  in  St.  Louis.  I 
have  often  cited  his  work  as  an  illustration  of  what  can  be  done. 
There  is  need  of  labor  legislation  to  bring  other  manufacturers  up 
to  his  standard. 

Mr.  Hammar  is  also  correct  in  his  contention  that  the  amount  of 
industrial  lead  poisoning  due  to  absorption  through  the  skin  is 
comparatively  insignificant.  Practically  all  industrial  lead  poison- 
ing, leading  authorities  agree,  is  caused  by  the  inhalation  or  the 
swallowing  of  lead  vapor  or  dust. 


286  American  Labor  Legislation  Review 

MRS.  FLORENCE  KELLEY,  National  Consumers'  League,  New  York 
City:  What  is  the  use  of  teaching  a  man  to  shovel  lead  and  then 
telling  him  it  is  harmful,  yet  paying  him  to  keep  it  up.  Is  there  any 
apparatus  on  the  market  to  prevent  that  phase  of  the  business? 

MR.  THOMPSON,  Chemist,  National  Lead  Company,  Neiv  York:  I 
came  here  on  account  of  our  interest  in  this  work.  I  want  to  say 
a  word  or  two  in  supplement  to  what  Mr.  Hammar  has  said  about 
dust.  In  our  experience  the  dust  is  the  dangerous  element.  In  re- 
gard to  mechanical  handling,  not  much  has  been  done  on  that  ques- 
tion, but  we  are  making  progress.  There  is  a  phase  in  the  manu- 
facture of  white  lead  not  yet  touched  on,  however,  which  illustrates 
one  direction  in  which  a  saving  of  dust  can  be  accomplished.  From 
the  time  when  you  put  the  white  lead  in  the  factory,  it  may  be 
handled  in  enclosed  machinery  and  no  dry  lead  dust  produced  until 
it  is  put  in  pans ;  and  even  that  can  be  avoided  by  mixing  it  with  oil. 
However,  the  trade  requirements  are  such  that  this  cannot  always  be 
done.  Some  painters  will  not  accept  such  paint. 

We  need  an  educational  movement,  to  be  followed  by  such  legis- 
lation as  is  necessary,  and  I  am  almost  inclined  to  think,  by  the 
time  the  legislation  is  accomplished,  the  manufacturers  will  have  done 
everything  that  will  be  required  of  them.  We  sympathize  heartily 
with  this  work  and  want  to  help  it  along  in  every  way  possible.  We 
are  spending  a  great  deal  of  money,  from  an  economic  standpoint, 
in  washrooms  and  in  new  machinery.  The  policy  of  our  company, 
and  I  speak  authoritatively,  is  not  to  hold  back  the  expenditure 
of  money  in  any  way  which  will  assist  in  the  prevention  of  lead 
poisoning. 

II.  INVESTIGATION  AND  REPORTING  OF  INDUSTRIAL  DISEASES 

DR.  GEORGE  M.  KOBER,  Georgetown  University,  Washington,  D. 
C.:  The  papers  presented  this  morning  are  particularly  valuable. 
Very  naturally  we  inquire  why  there  is  such  a  paucity  in  American 
literature  upon  this  subject.  The  reason  we  have  so  little  litera- 
ture is  that  we  have  had  few  original  investigations,  and  I  think  it 
is  exceedingly  encouraging  that  the  United  States  Labor  Bureau 
is  recently  paying  more  attention  to  the  question  of  industrial  dis- 
eases. I  consider  that  one  of  the  most  important  duties  the  bureau 
can  perform  is  to  have  expert  investigations  made  into  the  conditions 


General  Discussion  287 

affecting  the  workers'  health.  This  example  should  be  followed  by 
our  states.  More  money  should  be  spent  on  original  investigation, 
so  that  we  may  come  into  possession  of  facts  to  form  a  literature  on 
the  subject.  Then  we  need  the  training  of  men  and  women  to  this 
work. 

I  believe  the  reason  the  Germans  lead  in  literature  of  that  kind  is 
that  they  have  a  large  number  of  medical  officers  connected  with  in- 
dustrial insurance  companies,  whose  business  it  is  to  prevent  dis- 
ease and  who  naturally  give  special  attention  to  the  investigation  of 
factors  which  affect  the  welfare  of  workers.  We  may  benefit  the 
American  laborer  to  a  great  extent  by  encouraging  the  employment 
of  men  whose  business  it  is  to  give  their  entire  attention  to  the 
health  of  the  laborer.  The  ordinary  workman  often  hesitates  until 
he  is  really  compelled  to  give  up  work  before  asking  for  medical 
advice.  If  he  were  in  the  hands  of  a  physician  whose  duty  it  was  to 
give  attention  at  any  hour  of  the  day,  he  would  ask  advice  at  the 
earliest  possible  and  most  opportune  moment. 

I  wish  to  make  a  strong  plea  for  the  reporting  of  all  industrial 
diseases  in  every  state  in  the  union.  Until  we  do  this  many  dis- 
eases may  be  due  to  industrial  causes  but  not  be  recognized  as  such. 
We  should  also  train  up  medical  men  to  be  perfectly  conversant  with 
what  constitutes  industrial  disease. 

DR.  J.  W.  Foss,  Arizona:  I  have  had  some  experience  in  the  re- 
porting of  diseases,  and  the  question'  of  what  should  be  reported 
and  what  compensation  should  be  paid.  It  would  seem  right  to  ask 
the  labor  organizations  to  cooperate,  as  they  have  recently  done  in 
Arizona  in  regard  to  the  union  label.  They  sent  out  letters  to  all  the 
people  who  use  printed  matter  asking  them  to  use  that  label.  If 
the  physician  is  receiving  his  living  from  these  people  he  will  pay 
attention  to  their  request. 

DR.  WILLIAM  F.  SNOW,  California  State  Board  of  Health:  The 
California  legislature  of  1911  passed  a  law,  recommended  by  this 
Association,  requiring  the  reporting  of  six  occupational  diseases.  The 
bill  was  essentially  that  formulated  by  this  Association  but  with  one 
minor  change,  that  reports  should  be  made  to  the  state  board  of 
health  instead  of  to  the  bureau  of  labor  statistics.  The  state  board 
of  health  then  makes  a  transcript  of  the  report  and  immediately 
forwards  it  to  the  bureau  of  labor  statistics. 


288  American  Labor  Legislation  Review 

I  think  it  possible  that,  when  a  careful  survey  has  been  made,  we 
shall  find  that  California  does  not  have,  under  present  industrial 
and  limited  manufacturing  conditions,  a  large  problem  of  industrial 
disease.  We  are  doing  some  things,  however,  which  may  interest 
you.  The  labor  bureau  is  in  touch  with  the  labor  associations  of  the 
state  and  I  have  given  them  a  list  of  all  the  occupations  which  we 
thought  might  be  productive  of  industrial  diseases.  We  have  tried 
to  get  the  names  of  the  secretaries  of  all  the  painters'  unions  and  of 
all  the  printers'  unions.  We  are  also  trying,  in  the  principal  cities, 
to  obtain  information  in  regard  to  diseases  which  are  not  reported. 
That  is  joint  work  of  the  health  and  statistical  boards. 

The  physicians  are  the  biggest  factor  in  reporting.  If  we  could 
get  all  the  physicians  to  be  active  and  interested  and  to  study  the 
problem  and  see  the  importance  of  reporting,  it  would  be  a  great 
assistance. 

PROFESSOR  HENRY  R.  SEAGER,  Chairman:  I  am  sure  we  have  all 
listened  with  the  greatest  interest  to  Mr.  Hoffman's  stimulating  and 
salutary  paper.  It  is  just  the  sort  of  doctrine  we  need  as  social 
workers  to  keep  us  alive  and  aware  of  our  weakness.  But  I  think 
most  of  us  would  wish  to  put  in  a  caveat  against  his  description  of 
the  manufacturer.  He  has  had  in  mind  the  large-scale,  high-minded, 
far-seeing  employer.  There  are  many  of  that  type,  but  I  think  we 
must  not  forget  that  there  are  manufacturers  of  the  other  type  and 
that  the  presence  of  such  manufacturers  in  the  community  is  the 
justification  for  public  interference,  by  legislation  or  otherwise,  to 
remind  them  that,  while  tariff  protection  is  to  them  the  all-important 
thing,  to  the  community  at  large  protection  of  the  lives  and  health 
of  their  employees  is  even  more  important. 

Mr.  Hoffman  has  called  attention  to  the  paucity  of  literature  on 
the  subject  of  industrial  hygiene  and  the  difficulty  of  obtaining 
readily  the  literature  that  is  available.  We  hope  our  bibliography 
of  industrial  hygiene  will  serve  a  useful  purpose  by  giving  access 
to  this  literature. 

One  of  the  achievements  of  this  Association  has  been  the  enact- 
ment by  some  eight  states  of  a  law  requiring  the  reporting  of  certain 
industrial  diseases.  Dr.  Hatch's  paper  brings  out  very  clearly  the 
fact  that  in  this  work  we  have  passed  the  stage  of  talking  about  what 
we  ought  to  do  and  are  really  beginning  to  do  things  of  value.  I  wish 


"CHASER  ROOM"   IN   WHITE-LEAD   FACTORY 
MECHANICAL  MIXING  OF  DRY  LEAD  AND  OIL 

DRY  WHITE  LEAD  Is  SHOVELLED  FROM  THE  TRUCKS  INTO  THE  OPENINGS  UNDER 

THE  EXHAUST  PIPES  WHICH  CARRY  AWAY  MUCH  OF  THE 

DANGEROUS  DUST 

IN  ONE  MODERN  FACTORY  THE  CHASERS  ARE  ENTIRELY  ENCLOSED,  FILLED  BY 

MACHINERY  LIGHTED   BY   ELECTRICITY,   AND   INSPECTED  THROUGH 

GLASS  WINDOWS 


General  Discussion  289 

to  reen force  what  he  has  said  in  regard  to  the  cordial  cooperation 
that  this  Association  has  had,  in  connection  with  its  efforts  to  make 
the  reporting  law  a  success,  from  leading  physicians  in  New  York 
City.  It  must  be  admitted  that,  at  the  outset,  most  of  the  physicians 
we  communicated  with  were  not  enthusiastic  about  this  additional 
burden.  But  as  soon  as  it  was  explained  to  them,  their  attitude 
changed  and  we  have  had  their  cordial  cooperation.  I  hope  that 
the  plan  worked  out  in  New  York  State  may  serve  as  a  model  for 
the  other  seven  states  which  have  laws  requiring  the  reporting  of 
industrial  diseases. 


Ill 

HEALTH  PROBLEMS  IN  MODERN  INDUSTRY 


Presiding  Officer:  WARREN  COLEMAN 

Bellevue  and  Allied  Hospitals 

NEW  YORK  CITY 


THE    FUNCTION    OF     HOSPITALS    AND    CLINICS    IN 
THE   PREVENTION   OF  INDUSTRIAL  DISEASE 


RICHARD  C.  CABOT 
Massachusetts  General  Hospital,  Boston. 


What  are  the  hospitals  doing  to  prevent  industrial  disease  ?  Little 
or  nothing.  What  ought  they  to  be  doing?  Much.  Why?  Were 
hospitals  organized  to  do  preventive  work  and  to  follow  back  into 
the  community  all  the  medical  problems  that  the  community  shoots 
into  the  clinics?  No;  the  charters  and  constitutions  of  hospitals 
contain  no  distinct  evidence  of  any  such  provision.  But  public 
sentiment  is  beginning  to  demand  that  the  hospital  shall  advance,  as 
the  country  has  advanced,  beyond  the  thought  of  its  founders. 

Public  opinion  is  beginning  to  demand  that  hospitals  and  doctors 
alike  shall  do  something  to  abolish  the  need  of  their  own  existence — 
shall  make,  at  any  rate,  a  sincere  and  strenuous  effort  in  that  direc- 
tion. There  are  those  of  us  who  doubt  the  success  of  that  effort 
and  are  inclined  to  believe  that  the  prevention  of  industrial  disease 
is  largely  a  moral  problem  with  which  the  hospital  is  not  organized 
or  temperamentally  fitted  to  deal.  But  there  can  be  no  doubt  that 
the  public  is  putting  it  up  to  the  hospitals  to  deal  in  some  way  with 
the  many-spreading  branches  and  with  the  single  deep  root  of 
industrial  disease. 

Industrial  diseases,  such  as  lead  poisoning  and  "heat  cramps",  pass 
through  the  hospital  and  out  again  like  threads  in  a  loom.  They 
represent  but  one  of  many  such  threads  of  human  suffering  which, 
from  the  hospital  point  of  view,  suddenly  appear  out  of  the  wild 
jungle  of  the  modern  industrial  world,  are  visible  for  a  moment  in 
the  cleared  and  lighted  space  which  science  has  established  in  the 
clinic,  and  disappear  again  into  the  tangled  outside  world. 

It  is  precisely  because  there  are  so  many  such  threads,  besides 
that  leading  to  industry,  that  no  one  notices  or  follows  up  any  one 
of  them.  The  doctor's  mind  is  distraught  with  a  dim  awareness, 
"out  of  the  corner  of  his  mind's  eye",  of  this  mesh  of  threads.  He 
sees  not  only  occupational  diseases  but  recreational  diseases  (poi- 


294  American  Labor  Legislation  Review 

soned  recreations)  and  educational  maladies  due,  like  caisson 
disease,  to  the  crushing  pressure  of  many  atmospheres  on  sensitive 
minds,  or  to  rarefication  of  the  educational  atmosphere,  or  to  poi- 
sonous elements  introduced  in  education.  He  cannot  be  altogether 
oblivious  of  the  strands  which  bad  housing,  bad  cooking,  alcohol, 
morphine,  racial  misadaptation,  and  disillusionment  weave  into  the 
many-colored  fabric  of  misery  as  it  passes  through  his  clinic. 

If  he  had  been  challenged  only  by  the  disgrace  of  industrial 
disease,  he  might  have  long  since  picked  up  the  gauntlet  and  gone 
into  the  fight.  But  he  is  dimly  aware  that  industrial  disease  is  now 
in  the  limelight  chiefly  because  Mr.  John  B.  Andrews  and  a  few 
other  intelligent  people  have  recognized  the  horror  and  shame  that 
it  is  and  are  focusing  public  opinion  upon  it.  He  knows  that  poi- 
soned recreation  and  poisoned  education  are  disease-breeding 
factors  as  serious  as  poisoned  air,  and  that  the  housing  problem, 
the  immigration  problem,  and  the  drink  problem  do  as  much  as 
industrial  risks  to  keep  the  public  sick  and  the  hospitals  busy.  But 
he  also  knows  that  he  cannot  fight  all  of  the  giants  at  once  and 
unaided,  and  that  to  recognize  them  clearly  and  do  nothing  about 
them  would  render  his  medical  right  arm  powerless.  Hence,  with 
a  judicious  instinct  of  self-protective  adaptation,  he  turns  his 
attention  elsewhere. 

This  explains  why  our  hospitals,  though  called  upon  to  do  so 
much,  are  actually  doing  so  little  to  prevent  industrial  disease. 
Hospital  doctors  see  no  advantage  and  no  heroism  in  biting  off 
more  than  they  can  chew. 

But  the  reorganization  of  the  hospital  has  begun.  Its  forces  will 
soon  be  arranged  so  that  the  doctor  can  call  for  the  help  he  needs 
with  some  confidence  that  an  answer  will  come.  As  soon  as 
doctors  realize  this,  they  will  begin  calling  for  the  following: 

i.  Trained  investigators. — The  human  results  of  industrial 
disease  should  be  followed  up  to  their  source.  Was  it  the  patient's 
ignorance,  the  employer's  negligence,  the  law's  delay,  or  the  predis- 
posing influence  of  heredity  and  other  conditions  outside  the  field  of 
industry?  Whenever  one  case  of  industrial  disease  appears  at  a 
hospital  there  must  be  many  more  that  didn't.  These  others  must 
be  found. 

The  investigator  should  represent  the  hospital  and  not  an  outside 
agency,  because  the  hospital  occupies  a  position  of  judicial  fairness 


Hospitals  and  Clinics  in  Industrial  Disease  295 

and  impartiality.  It  is  quite  unconcerned  with  the  special  viewpoint 
or  class  consciousness  of  the  employer  or  of  the  employed.  It 
cannot  justly  incur  the  suspicion  of  either,  for  the  hospital  doesn't 
care  a  button  whose  fault  is  represented  in  industrial  sickness. 

2.  Educational  weapons. — As   a   result  of   the  efforts   of   these 
investigators,  excellent  illustrative  material  will  be  amassed  for  the 
prosecution  of  campaigns  of  education  among  employers,  employed, 
mem(bers  of  legislative  bodies,  and  the  general  public. 

The  recent  success  of  the  campaign  against  phosphorus  in  industry 
would  have  been  impossible  if  the  agitation  had  not  had  some  excel- 
lent pictures  of  the  effects  of  phosphorus  necrosis  on  the  jaw.  The 
hospitals  are  very  promising  fields  in  which  to  search  for  awful 
examples  of  this  kind,  and  the  examples  will  be  all  the  more  telling 
and  persuasive  if  they  are  found  by  the  hospitals'  own  agents  and 
not  by  outside  agencies  exposed  to  suspicion  of  prejudice. 

Pictures  illustrating  the  effects  of  diseases  and  the  devices  for 
preventing  them  should  be  on  the  walls  and  screens  of  every  clinic. 
They  accomplish  little  by  themselves,  but  if  you  lead  a  patient  up 
to  one  of  them  and  explain  the  picture  and  your  advice,  each  by 
means  of  the  other,  you  produce  a  far  deeper  effect  on  the  patient's 
mind  than  you  can  by  talk  alone.  A  clinic  thus  furnished  is  a 
permanent  exhibit  of  industrial  hygiene  and  one  likely  to  produce 
all  the  more  effect  because  of  its  connection  with  the  hospital. 
Hospitals  will  probably  be  slow  to  set  up  such  exhibits  by  them- 
selves, but  they  might  be  given  sets  of  pictures  on  trial  by  an 
organization  interested  in  industrial  hygiene. 

3.  Research  in  industrial  hygiene. — Such  research  will  naturally 
become  a  part  of  any  hospital  associated  with  a  medical  school  which 
maintains   an  active   department   of  preventive   medicine.      It   will 
concern  the  modes  by  which  industrial  disease  is  produced  and  those 
by  which  it  may  be  prevented. 

At  the  beginning  of  this  article  I  indicated  my  conviction  that  it 
is  the  hospital's  business  to  look  into  education,  recreation,  housing, 
and  alcoholism  as  causes  of  disease  for  the  same  reason  that  it  is  its 
business  to  look  into  industry.  Each  of  the  factors  just  mentioned 
is  as  important  as  industry  in  causing  illness  and  disability.  In 
closing  I  wish  to  say  that  just  because  the  hospital  physician  sees  the 
i5nterweaving  and  interlocking  of  all  these  factors  as  no  one  else 


296  American  Labor  Legislation  Review 

does,  he  is  pointed  out  by  the  finger  of  common  sense  as  the  man 
most  responsible  for  the  difficult  task  of  disentangling  them  and  de- 
ciding which  is  dominant  and  most  deserving  of  remedial  effort  Tu- 
berculosis, for  example,  is  sometimes  referred  to  as  an  industrial 
disease  and  doubtless  in  occasional  cases  it  is  so,  but  in  the  vast 
majority  of  cases  the  influence  of  other  factors,  such  as  nutrition, 
contagion,  and  housing,  is,  I  believe,  more  important.  The  hospital 
physician,  with  his  eye  on  all  these  factors,  can  take  a  more  impar- 
tial and  discriminating  view  of  the  tangled  problem  than  anyone 
else.  He  is  therefore  the  king-pin  in  the  whole  situation.  Let  us 
try  to  make  him  realize  the  honor  and  responsibility  thus  thrust  upon 
him! 


TEMPERATURE  AND  HUMIDITY  IN  FACTORIES 


C.-E.  A.  WINSLOW 
College  of  the  City  of  New  York. 


Discussion  of  certain  moot  points  in  the  theory  and  practice  of  ven- 
tilation has  become  so  general  and  sometimes  so  disputatious  that 
we  are  in  danger  of  losing  sight  of  the  underlying  facts  upon  which 
experts  are  in  substantial  agreement.  Yet  there  is  a  solid  basis  of 
accepted  principles  and  efficient  methods;  and  this  basis  is  amply 
sufficient  for  practical  application  on  the  part  of  individual  factory 
owners,  even  if  it  is  not  yet  so  concretely  defined  as  to  be  easily  em- 
bodied in  the  form  of  legislative  enactments. 

In  the  first  place,  it  is  quite  clear  that  the  principal  thing  which 
makes  the  air  of  confined  spaces  harmful,  aside  from  the  special 
problems  presented  by  dust  and  fumes,  is  overheating,  especially 
when  combined  with  excessive  moisture.  Any  temperature  over  70° 
F.  puts  a  strain  upon  the  heat-regulating  mechanism  of  the  body, 
keeps  the  blood  in  the  skin  away  from  the  vital  organs,  and  produces 
far-reaching  impairments  of  the  efficiency  of  the  nervous  system,  the 
digestive  system,  and  the  body  as  a  whole.  Changes  in  metabolism 
and  blood  pressure,  to  which  attention  has  recently  been  called  by 
Dr.  Oilman  Thompson,  are  similar  well-known  physiological  reac- 
tions to  temperature  change.  This  general  effect  of  heat  and 
humidity  is  familiar  to  everyone  who  contrasts  his  own  ability  to 
do  either  brain  work  or  muscular  work  in  the  dog-days  and  in  brisk 
autumn  weather.  It  is  established  by  the  exhaustive  studies  of 
physiologists  in  Germany,  in  England,  and  in  the  United  States; 
while  the  same  studies  have  as  yet  failed  to  reveal  any  definite  bad 
effects  due  to  the  chemical  constituents  of  the  air.  Other  atmos- 
pheric conditions  are  still  in  doubt.  The  best  lower  limit  of  tem- 
perature is  uncertain.  The  action  of  hot,  dry  air  is  debatable.  The 
physiological  effect  of  odors  in  air  has  not  been  demonstrated.  It 
is  beyond  question,  however,  that  the  workers  in  a  factory  where 
the  temperature  is  over  70°  are  injured  by  a  lowering  of  their 
vitality  that  may  lead  to  tuberculosis  and  other  serious  diseases ;  and 


298  American  Labor  Legislation  Review 

that  they  are  working  below  their  normal  standard  of  efficiency, 
so  that  both  they  and  their  employer  are  the  losers. 

The  New  York  State  Department  of  Labor  is  the  only  official 
body  in  this  country,  so  far  as  I  am  aware,  which  regularly  carries 
out  examinations  of  factory  air  and  publishes  the  results.  From 
the  reports  of  this  department  for  1908,  1909,  and  1910,  it  ap- 
pears that  two  hundred  and  fifteen  workrooms  were  examined 
at  seasons  when  the  outdoor  temperature  was  70°  or  less.  Of 
these  workrooms  one  hundred  and  fifty-six,  or  73  per  cent,  had  tem- 
peratures of  73°  or  over  and  sixty-three,  or  29  per  cent,  had  temper- 
atures of  80°  or  more.  In  a  recent  study  of  a  mill  village  carried  out 
by  the  Rhode  Island  Anti-Tuberculosis  Society,  temperature  and  hu- 
midity readings  were  taken  three  times  a  day  inside  and  outside  of  a 
weaving  room.  The  outdoor  temperature  for  the  month  (Septem- 
ber) averaged  65.5°.  The  temperature  in  the  weaving  room  aver- 
aged 75.8°,  10°  higher.  Is  it  not  clear  that,  aside  from  all  debatable 
questions,  there  is  a  simple  and  obvious  condition  here  which  di- 
rectly menaces  the  health  of  the  workers  and  impairs  the  efficiency 
of  industry? 

The  first  clear  problem  of  air  conditioning  in  the  factory  is  the 
prevention  of  overheating.  The  practical  method  of  attaining 
this  end  is  air  change  or  ventilation.  With  only  a  few  people  in 
a  room,  heat  may  be  transferred  through  cracks  and  through 
the  substance  of  walls  and  ceiling  with  sufficient  rapidity,  without 
any  special  provision  for  the  purpose.  Where  many  workers 
are  crowded  together,  however,  this  is  impossible.  The  average 
human  being  at  work  produces  about  two  hundred  and  fifty  calories 
of  heat  per  hour,  equivalent  to  the  heat  liberated  by  the  burn- 
ing of  two  candles.  In  many  factories  this  heating  effect  is  sup- 
plemented by  the  friction  of  machinery  and  the  combustion  of 
illuminants,  and  often  by  furnaces,  mangles,  steam  jackets,  press- 
ing irons,  solder  pots,  and  other  direct  sources  of  heat.  The  most 
convenient  method  of  removing  this  excess  heat  is  by  air  change; 
and  the  primary  need  in  factory  ventilation  is  to  provide  for  the 
removal  of  the  heated  air  and  its  replacement  by  cooler  air  from 
without.  The  latter  must  usually  be  first  tempered  by  raising  it 
to  a  point  a  little  below  that  which  is  normally  felt  to  be  com- 
fortable. Whatever  may  be  the  case  in  hospitals  and  schools,  it 
is  fairly  certain  tha.t  incoming  air  much  below  60°  would  not  be 


Temperature  and  Humidity  in  Factories  299 

endured  by  factory  operatives;  and  it  would  certainly  not  be 
compatible  with  efficiency  in  the  majority  of  trades  which  call 
for  manual  dexterity. 

I  am  speaking  in  this  connection  of  the  maintenance  of  ordinary 
normal  atmospheric  conditions  in  the  factory.  The  possibility  of 
occasional  variations  from  this  normal  is  a  separate  question.  It 
is  maintained  by  many  sanitarians  that  changes  in  temperature  are 
stimulating  and  beneficial.  There  is  little  exact  evidence  for  this 
view,  but  it  is  in  harmony  with  general  experience  and  is  probably 
correct.  In  many  schools  it  is  the  practice  to  open  windows  and 
flush  out  the  room  with  cold  "air  every  two  hours  or  so,  and  the 
effect  upon  the  spirit  and  efficiency  of  the  pupils  is  said  to  be 
excellent.  Such  a  procedure  might  be  well  worth  the  temporary 
interruption  of  work  in  many  industrial  processes.  It  is  merely 
a  modification  of  a  general  system  of  air  conditioning,  however, 
not  a  separate  system  by  itself.  The  fundamental  problem  is 
the  exhaustion  of  the  hot  air  of  the  workroom  and  the  supply 
of  cool  but  tempered  air  to  take  its  place.  I  shall  not  dwell  upon 
the  methods  by  which  this  end  can  be  attained,  since  they  differ 
in  each  individual  case.  In  general,  I  believe  the  hot  air  should 
be  taken  out  near  the  top  of  the  room  and  the  cool  air  admitted 
near  the  bottom.  The  hot  air  may  escape  by  its  own  tendency 
to  rise  or  may  be  sucked  out  by  fans.  The  cool  air  may  be  ad- 
mitted at  window  openings  in  the  room,  equipped  with  tempering 
coils;  or  it  may  be  forced  from  a  central  point  through  special 
ducts.  The  system  of  ventilation  may  or  may  not  be  supplemented 
by  a  direct  system  of  heating.  The  essential  principle  remains 
unchanged. 

When  we  pass,  however,  to  the  question  of  embodying  desirable 
conditions  in  statutory  form,  which  is  the  primary  object  of 
your  Association,  the  matter  is  not  so  simple.  At  present  there 
are  only  two  types  of  laws  on  the  statute  books  of  American  states, 
with  the  exception  of  the  1909  law  of  Illinois.  Eight  or  ten  states 
provide  for  a  minimum  cubic  space  per  occupant,  usually  two 
hundred  and  fifty  or  four  hundred  cubic  feet.  Some  twenty 
states  require  that  factories  shall  be  "ventilated"  or  "well  venti- 
lated" or  "sufficiently  ventilated".  The  cubic  space  requirement 
by  no  means  insures  good  air  conditions.  It  merely  prohibits 
such  a  state  of  overcrowding  that  proper  air  conditions  are  in> 


3OO  American  Labor  Legislation  Review 

possible.  Whether  a  factory  with  ample  air  space  is  comfortable 
or  not  depends  on  the  further  provision  for  air  change.  In  the 
studies  made  by  the  English  departmental  committees  it  was 
found  that  the  air  was  no  better  on  the  average  in  factories  with 
over  five  thousand  cubic  feet  of  air  space  per  occupant  than  in  those 
with  an  air  space  under  three  hundred  cubic  feet.  As  to  the  provisions 
that  factories  must  be  "ventilated"  or  "well  ventilated",  they  are 
unenforceable  and  meaningless  in  the  hands  of  the  present  de- 
partments charged  with  factory  inspection  in  this  country.  The 
Illinois  law  is  the  only  real  ventilation  law  in  the  United  States. 
It  provides  that  a  definite  amount  of  air,  1500  to  1800  cubic  feet 
per  occupant,  according  to  specified  conditions,  shall  be  supplied, 
unless  the  cubic  space  in  the  workroom  be  over  2000  cubic  feet 
per  occupant  and  the  outside  window  and  door  space  be  equal  to 
one-eighth  of  the  floor  space. 

In  formulating  a  standard  for  factory  ventilation  one  is  met 
at  the  outset  by  the  question  whether  the  standard  should  be  a 
mechanical  or  an  analytical  one.  Ventilating  engineers  prefer  to 
have  the  amount  of  air  supply  fixed  as  in  the  Illinois  law.  Sani- 
tarians argue  that  the  proper  standard  is  the  actual  condition 
maintained  in  the  workroom,  however  it  may  be  reached.  In  a 
proposed  law  drafted  in  conference  with  members  of  this  Asso- 
ciation in  New  York  a  year  ago  and  introduced  in  the  state  leg- 
islature as  Senate  Bill  No.  1019,  on  March  31,  1911,  an  attempt 
was  made  to  combine  these  two  viewpoints  on  an  alternative  basis. 
This  bill  provided  that  "a  workroom  shall  be  deemed  to  be  prop- 
erly and  sufficiently  ventilated  if  the  air  in  the  working  parts 
thereof  does  not  contain  more  than  nine  parts  of  carbon  dioxid 
in  10,000  volumes  of  air  in  excess  of  the  number  of  parts  of  car- 
bon dioxid  in  10,000  volumes  of  the  exterior  air,  or  if  there  is 
constantly  supplied  throughout  the  interior  of  the  room  at  least 
1200  cubic  feet  of  air  per  hour  for  each  person  therein  present 
and  employed  and  in  addition  thereto  at  least  1000  cubic  feet  of 
air  per  hour  for  each  cubic  foot  of  gas  burned  per  hour".  Such  a 
law,  which  demands  a  reasonable  rate  of  air  change,  to  be  demon- 
strated either  by  analysis  or  on  a  mechanical  basis,  seems  eminently 
fair  to  the  manufacturer  and  probably  safeguards  sufficiently  the 
health  of  the  worker  so  far  as  the  extent  of  air  change  is  concerned. 

Any  ventilation  standard  must,  however,  deal  .with  the  quality  a? 


Temperature  and  Humidity  in  Factories  301 

well  as  with  the  quantity  of  the  air.  The  most  important  things 
are  the  temperature  and  humidity  of  the  air.  These  qualities  are 
measured  very  simply  by  the  use  of  an  instrument  known  as  the 
sling-psychrometer,  which  consists  of  a  pair  of  thermometers,  one 
of  the  ordinary  type  and  the  other  having  its  bulb  covered  by  a  wet 
cloth.  Moisture  evaporates  from  the  wet  cloth  at  a  rate  determined 
by  the  amount  of  moisture  in  the  air  and  this  evaporation  cools  the 
wet-bulb  thermometer  and  lowers  the  temperature  recorded.  From 
the  temperature  of  the  dry-bulb  thermometer  and  the  difference 
between  the  dry  and  wet  bulb,  the  moisture  in  the  air  may  be  readily 
calculated.  A  high  wet-bulb  reading  means  a  combination  of  tem- 
perature and  humidity,  precisely  the  condition  most  harmful  to  the 
human  organism,  and  Haldane  has  shown  that  in  general  a  given 
wet-bulb  reading  has  about  the  same  physiological  effect,  whether 
it  be  the  result  of  a  very  high  temperature  with  low  humidity  or  of 
a  moderately  high  temperature  combined  with  high  humidity.  The 
proposed  New  York  law,  to  which  reference  has  been  made,  pro- 
vided that  "the  temperature  in  any  factory  workroom  except  a 
boiler  room,  shall  not  exceed  72°  F.  as  determined  by  the  wet-bulb 
thermometer,  unless  the  temperature  of  the  exterior  air  exceeds  70° 
F.  as  determined  by  the  same  process,  in  which  case  the  wet-bulb 
temperature  shall  not  exceed  that  of  the  exterior  air  by  more  than 
5°."  A  wet-bulb  temperature  of  72°  would  correspond  to  a  dry- 
bulb  temperature  ranging  from  72°  with  completely  saturated  air 
to  93°  with  air  containing  only  30  per  cent  relative  humidity. 

It  is  just  here  that  the  difficulty  comes  in  formulating  a  standard 
for  factory  ventilation.  Either  the  Illinois  law  or  the  proposed 
New  York  law  would  serve  pretty  well  to  regulate  the  amount  of 
air  to  be  supplied.  I  do  not  believe,  however,  that  we  have  ade- 
quate data  for  fixing  a  maximum  figure  for  temperature  and  hu- 
midity. The  limit  of  72°  wet  bulb  written  into  the  proposed  New 
York  law  was  taken  as  a  maximum  which  would  probably  not  be 
onerous  to  the  manufacturer,  but  it  is  possible  that  even  this  limit 
might  be  difficult  of  attainment  in  certain  industries,  while  in  most 
factories  it  is  probable  that  a  much  more  stringent  regulation 
could  well  be  adopted.  Industrial  processes  are  very  diverse  and 
any  rigid  statutory  standard  is  likely  to  work  hardship  on  the  one 
hand  and  to  give  inadequate  protection  to  the  worker  on  the  other. 
As  Socrates  long  ago  taught  his  ardent  pupil  Glauco  in  the  Mem- 


302  American  Labor  Legislation  Review 

crabilia,  it  is  no  light  matter  to  make  laws  governing  industrial 
conditions.  Standards  for  factories  can  only  be  wisely  formulated 
after  a  careful  study  of  existing  conditions  in  the  light  of  physio- 
logical ideals  and  by  striking  a  fair  balance  between  what  we 
should  like  and  what  the  factory  owner  can  reasonably  provide. 
In  our  own  homes  we  maintain,  not  a  wet-bulb  maximum  of  72°, 
but  a  dry-bulb  maximum  of  70°,  a  very  different  thing.  How  near 
this  desirable  ideal  the  legal  limit  should  be  placed  can  only  be  de- 
termined by  a  careful  study  of  present  conditions  and  practical 
possibilities  in  specific  trades. 

The  old  English  law  governing  conditions  in  cotton-weaving 
sheds  provided  that  in  sheds  in  which  there  was  artificial  humidi- 
fication  the  limit  for  carbon  dioxid  should  be  nine  parts  per  10,- 
t»oo,  and  fixed  a  definite  relation  between  wet  and  dry-bulb  tem- 
peratures for  each  dry-bulb  temperature  over  a  wide  range,  but 
set  practically  no  upper  limit  for  either.  With  the  advance  of 
modern  ideas  as  to  the  supreme  importance  of  temperature  in  air 
conditioning  the  whole  question  was  reopened  by  the  creation  of  a 
departmental  committee  which  heard  ninety-six  witnesses,  including 
physiologists,  factory  inspectors,  mill  owners  and  operatives,  made 
seventy-six  inspections  and  numerous  air  examinations,  published 
the  results  in  two  hundred  and  fifty  closely  printed  pages  and 
formulated  a  new  standard  raising  the  carbon  dioxid  limit  to  eight 
parts  in  excess  of  that  in  the  outside  air  and  adding  a  temperature 
limit  of  75°  wet  bulb.  All  this  was  done  for  one  branch  of  one 
industry;  precisely  this  sort  of  investigation  is  urgently  needed  in 
the  United  States. 

In  view  of  the  difficulty  of  formulating  legal  standards,  Wis- 
consin has  adopted  an  entirely  different  plan,  abandoning  entirely 
the  attempt  to  fix  the  details  of  factory  regulation  in  the  form  of 
law  and  creating  instead  an  industrial  commission  with  power  to 
fix  specific  standards  whose  reasonableness  can  be  reviewed  only 
by  the  supreme  court  of  the  state.  The  regulations  of  such  a  com- 
mission could  be  made  far  more  responsive  to  the  varied  and  chang- 
ing conditions  of  science  and  industry,  and  would  offer  the  most 
promising  method  of  securing  a  maximum  of  protection  for  the 
worker  with  a  minimum  burden  on  the  business  itself. 

It  is  quite  as  essential,  however,  for  the  work  of  such  a  commis- 
sion as  for  the  formulation  of  specific  laws,  if  that  method  of  pro- 


Temperature  and  Humidity  in  Factories  303 

cedure  be  preferred,  that  a  thorough  study  of  existing  factory  con- 
ditions by  properly  qualified  experts  should  be  made.  There  have 
recently  been  valuable  studies  of  certain  industrial  poisonings  in 
this  country,  notably  by  the  Illinois  Commission  on  Occupational 
Diseases  and  by  Dr.  Andrews,  the  secretary  of  this  Association. 
General  sanitary  conditions,  and  particularly  air  conditioning,  are 
far  more  important  in  the  aggregate  than  these  specific  poisonings. 
The  latter  are  obvious  and  spectacular,  but  they  only  affect  a  com- 
paratively small  fraction  of  the  working  class.  Even  in  the  pottery 
industry,  one  of  the  trades  most  subject  to  lead  poisoning,  it  was 
shown  in  England  by  the  departmental  committee  on  this  industry 
that  the  excess  death  rate  due  to  plumbism  was  only  .8  per  1000 
while  the  excess  death  rate  due  to  tuberculosis  was  7.0.  Industrial 
tuberculosis  pervades  not  only  the  dusty  trades,  but  in  less  degree 
every  industry  from  the  largest  to  the  smallest.  Yet  as  to  air  con- 
ditioning in  our  factories  we  know  pitiably  nothing  and  we  have  no 
machinery  for  finding  out  anything.  New  York  has  a  good  medical 
and  laboratory  expert  in  Dr.  Graham-Rogers.  Illinois  has  recently 
appointed  a  medical  expert  from  whom  we  are  to  hear  to-morrow. 
Massachusetts  has  a  force  of  fifteen  medical  inspectors  devoting 
some  or  all  of  their  time  to  the  work.  This  is  all  that  we  have  in 
the  way  of  scientific  factory  inspection  in  the  whole  United  States. 
For  progress  in  air  conditioning  it  is  essential  to  have  air  exami- 
nations and  intelligent  inspection  of  ventilating  appliances  in  fac- 
tories of  various  types.  Only  on  the  basis  of  such  studies  can  legal 
standards  be  enacted  or  specific  rules  laid  down  by  a  factory  com- 
mission. Yet  we  have  in  the  whole  United  States,  except  for  Dr. 
Graham-Rogers  in  New  York,  not  one  single  chemist  or  engineer 
regularly  employed  by  any  state  to  study  factory  air  conditioning. 

Would  it  not  be  well  for  this  Association  to  take  up  seriously  at 
this  time  the  problem  of  expert  organization  of  the  state  bureaus 
which  are  supposed  to  deal  with  industrial  hygiene  and  sanitation? 
It  is  less  standards  that  we  need  than  experts  to  formulate  new 
standards  and  enforce  the  old  ones.  There  should  be  medical 
experts  and  chemical  experts  and  engineering  experts, — not  just 
doctors  and  engineers,  but  doctors  and  engineers  who  have  spe- 
cialized in  public  health, — on  the  staff  of  the  body  which  enforces 
health  laws  in  factories  in  every  large  industrial  state;  and  we 
shall  not  get  much  farther  with  the  problems  on  hand  until  this 
comes  to  pass. 


304  American  Labor  Legislation  Review 

Meanwhile,  however,  there  is  an  excellent  opportunity  for  the 
individual  factory  owner  to  benefit  his  employees  and  increase  their 
output  by  attention  to  the  problem  of  air  conditioning  as  regards 
temperature  and  humidity.  There  should  be  a  thermometer  in 
every  workroom  and  the  foreman  should  be  made  to  understand 
that  every  time  the  temperature  passes  70°  he  is  failing  to  secure 
the  best  work  from  his  hands.  In  any  large  factory,  observations 
of  ordinary  temperatures  should  be  supplemented  by  the  use  of  the 
sling-psychrometer.  Only  by  such  observations  can  window  venti- 
lation in  small  shops  and  ventilation  systems  in  large  factories  be 
intelligently  controlled.  Direct  practical  results  in  diminishing  ab- 
sences and  decreasing  damaged  and  imperfect  work  have  been 
obtained  in  many  a  factory  by  improved  air  conditioning.  Efficien- 
cy methods  have  been  applied  to  a  hundred  mechanical  details  of 
shop  administration.  That  delicate  mechanism  the  human  body  is, 
however,  the  underlying  factor  which  is  after  all  of  most  impor- 
tance. Yet  in  many  a  workshop,  perhaps  in  most  workshops,  the 
human  body  is  being  operated  under  conditions  which  preclude  its 
maximum  effectiveness,  and  the  work  suffers  while  the  sanitariums 
fill  up  with  cases  of  industrial  tuberculosis. 


AIR  IMPURITIES— DUSTS,  FUMES,  AND  GASES 


CHARLES  BASKERVILLE 
College  of  the  City  of  New  York. 


The  nature  and  extent  of  air  impurities  discussed  in  this  paper  are 
dependent  upon  local  conditions.  For  our  purposes  these  air  im- 
purities may  be  classified  under  three  heads:  namely,  (i)  dusts,  (2) 
fumes,  and  (3)  gases.  These  divisions  are  not  exclusive,  as  fumes 
in  abundance  may  become  dusts;  for  example,  a  sudden  escape  of 
white  arsenic  fumes  results  in  a  cloud  of  dust.  Again,  smelter 
fumes  (mainly  sulfur  dioxid),  much  diluted,  may  be  classed  as 
gaseous.  The  classification,  therefore,  is  neither  specific  nor  de- 
pendent upon  inherent  properties  of  the  materials.  It  is  merely  a 
convenience  and  must  admit  of  a  broad  and  liberal  interpretation.  A 
technical  discussion  as  to  proper  lines  of  differentiation  would  be  of 
little  profit  and  less  interest. 

INDUSTRIAL  DUSTS 

It  is  well  known  that  various  industrial  dusts  cause  irritation  of 
the  respiratory  passages  and  of  the  eyes  and  skin  of  workmen.  Such 
dusts  may  be  considered  in  three  classes :  namely, — 

I.  Insoluble  inorganic  dusts. — This  class  includes  metals  (anti- 
mony, arsenic,  type-metal,  brass,  bronze,  copper,  aluminum,  iron, 
steel,  lead,  manganese,  vanadium  and  ferro-vanadium,  silver,  tin, 
zinc,  and  solder)  in  a  state  of  fine  division  (dusts,  atomized  metals, 
metallic  powders);  flue  dusts;  various  ore  dusts  (iron  ore,  etc.); 
silica,  sand,  emery,  flint,  glass  powder;  carbon,  graphite,  diamond, 
coal,  soot;  brick  dust,  marble,  granite,  cement,  terra-cotta;  lime, 
gypsum,  plaster,  meerschaum;  phosphates,  guano,  etc. 

Fibrosis  of  the  lungs  may  result  from  the  inhalation  of  silicious 
or  metallic  particles;  for  example,  we  have  "potter's  asthma"  and 
"grinder's  phthisis"  (chronic  catarrhal  bronchitis  among  knife- 
grinders).  Pneumonia  has  been  reported  as  frequent  among  work- 
men in  blast-furnaces,  in  part  owing,  directly  or  indirectly,  to  the 


306  American  Labor  Legislation  Revieiv 

inhalation  of  slag  dust ;  cardiac  dilation  is  said  to  occur  among  work- 
men in  slate  quarries;  ankylostomiasis  among  brickmakers,  miners, 
etc.;  and  recurrent  inflammation  of  bone  with  hypertrophy  among 
pearl-dust  workers. 

Hellthaler1  has  shown  the  high  rate  of  death  among  various  classes 
of  metal  workers  in  America  who  are  apparently  in  ignorance  of 
the  peculiar  dangers  of  their  occupations;  and  Prinzing2  has  demon- 
strated the  high  death  rate  from  phthisis  among  steel  grinders  and 
other  workmen  at  Solingen,  Germany,  for  the  years  1885  to  1895.  It 
is  certain  that  the  inhalation  of  iron  dust  may  diminish  in  time  the 
respiratory  efficiency  of  the  lungs  through  a  loss  in  their  elastic 
property ;  or  may  reduce  the  resistance  of  the  organs  to  invasion  by 
harmful  bacteria ;  or  may  infect  the  lungs  through  a  transportation 
of  disease  germs  to  places  favorable  for  their  inoculation.  The 
disease  known  as  siderosis  exists  commonly  among  metal  polishers, 
knife-grinders,  and  others  engaged  in  metal  working.  The  earliest 
symptoms  of  this  disease  are,  according  to  Soper,3  catarrh  and  bron- 
chitis, but  shortness  of  breath  is  pronounced  by  all  authorities  to  be 
the  most  characteristic  symptom.  Eventually  there  follows  what 
appears  to  be  phthisis  without  the  presence  of  tubercle  bacilli,  yet 
genuine  infective  phthisis  is  the  most  common  cause  of  death.  The 
effects  may  be  delayed  for  years,  but  metal  working  is  indeed  a  dan- 
gerous occupation;  undoubtedly  many  die  from  infectious  pulmo- 
nary diseases  who  do  not  know  that  the  breathing  of  dusty  air  has 
led  to  their  infection. 

With  the  development  of  rapid  transit  systems  in  modern  cities, 
it  may  be  well  to  direct  attention  to  a  new  and  specific  form  of  city 
dust  investigated  by  Dr.  Soper,4  who  found  that  the  average  weight 
of  dust  in  subway  air  was  61.6  mg.  per  1,000  cubic  feet  of  air,  or 
2.25  mg.  per  cubic  meter.  The  figures  for  the  streets  were  1.83  mg. 
per  cubic  meter.  The  subway  dust  was  found  to  consist  chiefly  of 
angular  particles  of  iron,  but  no  case  of  siderosis  seemed  to  have  been 
reported. 

2.  Soluble  inorganic  dusts. — This  class  comprises  such  substances 

1  Hellthaler,  "The  Death  Claims."  The  Independent,  December  27,  1906,  v. 
61 11560. 

3  Prinzing,  Handbuch  dcr  Mcdizinischen  Statistik,  1906,  p.  489. 
'  Soper,  The  Air  and  Ventilation  of  Subways,  1908,  p.  205. 
*  Ibid.,  p.  200. 


Air  Impurities — Dusts,  Fumes,  and  Gases  307 

as  are  likely  to  be  swallowed  and  absorbed,  and  includes:  metal 
particles  (lead,  brass,  copper,  zinc,  arsenic,  mercury,  and  silver) 
and  soluble  inorganic  salts.  Many  dusts  of  this  class  are  dangerous, 
not  only  because  of  their  irritating  or  poisonous  properties,  but  also 
because  of  their  inflammability, — e.  g.,  potassium  chlorate. 

3.  Organic  dusts. — This  class  comprises  sawdust,  fur,  skins, 
feathers,  broom  and  straw,  grain  and  flour,  jute,  flax,  hemp,  cotton, 
wool,  carpet  dust,  street  sweepings,  tobacco  and  tobacco-box  dust, 
hides  and  leather,  felts,  rags,  paper,  horsehair,  etc. 

As  representative  diseases  caused  by  organic  dusts  we  have :  "flax- 
dresser's  disease",  a  kind  of  pneumonia  due  to  the  inhalation  of  par- 
ticles of  flax ;  pneumokoniosis  due  to  the  inhalation  of  dust  by  gannis- 
ter  workers ;  alkaloidal  poisoning  from  African  boxwood  by  workmen 
engaged  in  shuttle  making;  and  malignant  pustule  and  a  febrile 
disease  among  rag-sorters.  As  in  the  other  classes,  the  components 
of  this  class  of  dusts  are  all  irritating  to  the  respiratory  tract  and  to 
the  eyes,  and  especially  are  they  capable  of  forming  inflammable, 
and  even  explosive  mixtures  with  air.  In  addition,  there  are  various 
trade  eczemas,  and  anthrax  has  been  frequently  reported  among 
wool-sorters. 

The  solution  of  the  industrial  dust  problem  presents  many  diffi- 
culties. Undoubtedly,  however,  disease  from  dust  may  be  much  re- 
duced by  the  following  procedures: 

(a)  Those   engaged   in   the   following  occupations   should   wear 
"workmen-respirators" :  sorting  rags  in  paper  factories ;  workmen  on 
threshing  machines ;  millers ;  batch-mixers  in  glass  factories ;  stone- 
cutters and  sculptors;  and  all  those  working  in  factories  where  the 
air  is  contaminated  with  irritating  or  poisonous  dust. 

(b)  Those  employed  in  the  manufacture  of  oxidizing  agents  and 
lead  workers  should  be  compelled  to  change  their  clothes  before 
leaving  the  factory.    This  is  done  now  in  some  works  in  this  country. 

(c)  Glasses  for  the  protection  of  the  eyes  of  workmen  should  be 
looked    upon   as   necessary    in    plants    where    irritating    dusts    are 
unavoidable. 

(d)  The    dust   on   the    floors   of   printing,    type-casting,   metal- 
working,  and  other  establishments  may  be  laid  by  means  of  certain 
useful  preparations.     Heise5  considers  those  consisting  entirely  of 
non-drying  (mineral)  oils  to  be  the  best  for  the  purpose. 

6  Heise,  Arb.  Kais.  Gesundh. — Ami,  1909,  v.  30:93. 


308  American  Labor  Legislation  Review 

Where  vapors  are  likely  to  occasion  industrial  poisoning,  ventila- 
tion will  serve  to  prevent  their  accumulation ;  but  in  the  case  of  dusts, 
economic  considerations  often  render  such  a  procedure  difficult 
except,  of  course,  as  the  maintenance  of  normal  ventilation  assists 
in  their  elimination. 

..  i 

NOXIOUS   FUMES,    GASES,    AND   VAPORS 

The  air  of  cities  and  towns  where  chemical  manufactories  exist 
is  often  contaminated  with  noxious  gases  of  industrial  origin  which 
are  dangerous  to  the  health  of  the  workmen  employed  in  the  in- 
dustries. The  usual  gases  which  give  rise  to  complaint  in  manu- 
facturing localities  are  the  following:  chlorin,  which  is  emitted 
by  pottery  kilns  and  ceramic-products  manufactories,  and  from 
plants  for  the  electrolysis  of  halides;  hydrogen  chlorid,  which  is 
produced  by  the  combustion  of  coal,  and  by  pottery  kilns,  ceramic- 
products  manufactories  (partly  from  the  coal  and  partly  from  the 
clay),  nickel  and  cobalt  smelting,  platinum  refining,  glass  manufac- 
tories, fertilizer  manufactories,  the  chlorid  of  lime  industry,  and 
alkali  manufactories ;  sulfur  dioxid  and  sulfuric  acid,  which  result 
from  the  combustion  of  coal,  coke,  petroleum,  and  gas,  copper  smelt- 
ing, bleaching  operations,  etc. ;  fluorides  and  hydrofluoric  acid,  which 
are  emitted  from  acid  phosphate  and  heavy  chemical  plants ;  hydro- 
gen sulfid,  from  chemical  works,  especially  those  which  produce 
ammonia;  carbon  monoxid,  which  is  emitted  from  iron  furnaces 
and  from  copper  smelters ;  organic  vapors,  from,  for  example,  glue 
refineries,  bone  burners,  slaughter  and  packing  houses;  zinc  fumes 
from  zinc  smelters  and  from  brass  foundries ;  arsenical  fumes  from 
copper  smelters;  phosphoric  fumes  from  match  manufactories;  and 
carbon  disulfid  and  sulfur  chlorid  from  some  rubber  works. 

Lehmann6  compiled  the  accompanying  table  from  the  reports  of 
many  investigators,  to  show  at  what  concentrations  the  various  com- 
mon industrial  gases  are  capable  of  producing  immediate  and  observ- 
able effects  upon  health.  The  destructive  action  of  fumes  in  the 
vicinity  of  chemical  plants  is  generally  due,  however,  to  the  presence 
of  sulf urous  acid,  sulfuric  acid,  or  hydrochloric  acid ;  and  this  table 
is  given  on  account  of  the  occupational  hazards  on  the  part  of  work- 
men employed  in  chemical  manufactories  and  smelters. 

•Lehmann,  Methoden  der  Praktisch  en  Hygiene,  1901,  p.  174. 


Air  Impurities — Dusts,  Fumes,  and  Gases 


309 


NAME  OF  GAS 

Rapid  and 
dangerous 
injury 

Bearable  for 
30  to  60  min. 
without  grave 
effects 

Trifling  symp- 
toms after  action 
for  some  hours 

Hydrochloric   acid  per 
Sulfurous  acid        •    .     " 

IOOO 
IOOO 

1-5—2 

O4  —  5 

0.05 

oo^ 

O.OI 

Carbonic  acid                  " 

IOOO 

About  30 

6  to  8 

I    tO  2 

Ammonia                   .  .     " 

IOOO 

2  ^  —  4  ^ 

o  ^ 

O  I 

Chlorin  *    Bromin            " 

IOOO 

004  —  o  06 

0004 

OOOI 

Iodine                                " 

IOOO 

0003 

o  005  —  o  001 

Hydrogen  sulfid     " 
Carbon  disulfid                " 

IOOO 
IOOO 

0.5-07 
OOI 

0.2—0.3 

O  OO2 

0.1—0.15 

0  OOI 

Carbon    monoxid    " 

IOOO 

2  to  3 

0.5—1.0 

O.2 

Of  the  gases  which  affect  the  respiratory  passages  and  eyes  the 
most  important  are  the  following :  illuminating  gas,  gases  from  coke 
and  coal;  carbon  monoxid;  carbon  dioxid  (in  brewing,  baking,  and 
the  manufacture  of  aerated  waters)  ;  chromic  acid;  chlorin;  sulfuric, 
hydrochloric  and  nitric  acids,  and  nitrogen  oxids  (in  acid  factories, 
heavy  chemical  works,  engraving,  etching,  lithographing,  etc.)  ;  mer- 
cury cyanid ;  heated  lead ;  ammonia ;  naphtha  and  benzine  (petroleum 
refineries  and  dry-cleaning  establishments)  ;  arseniuretted  hydrogen 
(copper  refineries)  ;  sulfur,  hydrogen  sulfid,  sulfur  dioxid,  and  car- 
bon disulfid,  sulfur  chlorid,  nitrous  gases,  hydrocyanic  acid;  smoke 
(fire  extinguishing)  ;  and  the  vapors  of  various  organic  compounds 
and  substances  (tar,  creosote,  carbolic  acid,  petroleum  and  its  pro- 
ducts, methyl  alcohol,  fusel-oil,  varnish  solvents,  dinitrobenzol,  nitro- 
glycerine, formaldehyde  and  formic  acid,  pyridin,  etc.).  In  addition 
to  irritating  the  respiratory  tract  and  eyes,  such  substances  as  the 
halogens,  mineral  acids,  formic  acid,  alkalies,  creosote  and  carbolic 
acid,  various  dyes,  etc.,  cause  injuries  to  the  skin,  giving  rise  to 
burns,  eczema,  fissures,  ulcers,  etc.  It  has  been  said  that  workmen 
in  by-product  coke  plants,  coal-tar  color  works,  and  in  the  roofing 
and  paving  industries  are  troubled  with  epitheliomatous  cancer  or 
ulceration  of  the  skin  or  of  the  corneal  surface  of  the  eye,  owing 
to  constant  exposure  to  pitch  and  tar  compounds ;  that  workers  with 
chromates,  tanners,  and  dyers  have  "chrome  ulceration"  of  the  skin ; 
and  that  there  are  various  trade  eczemas,  often  of  a  troublesome 
nature. 

Virtually  no  accidents  have  been  recorded  with  hydrogen  chlorid 
gas,  and  accidents  with  hydrocyanic  acid  gas  and  arseniuretted 


3io  American  Labor  Legislation  Review 

hydrogen  are  not  of  frequent  occurrence  in  American  plants.  Car- 
bon monoxid  occurs  in  colliery  workings  after  explosions,  in  gas 
producers,  blast-furnace  gases,  and  in  the  manufacture  of  calcium 
carbid  and  phosphorus ;  hydrogen  sulfid  occurs  in  gas-liquor  storage 
tanks,  gas  purifiers,  sulfate  stills  and  saturators,  and  in  sewers; 
chlorin  is  found  in  and  about  bleaching-powder  chambers,  mangan- 
ese stills,  and  Deacon  and  other  chlorid  plants;  and  nitrous  and 
nitric  acid  fumes,  which  are  very  insidious  in  their  action,  are  met 
with  in  vitriol  chambers,  especially  in  Gay-Lussac  towers,  during 
repacking  and  cleaning,  in  the  manufacture  of  nitrate  of  iron  and 
nitric  acid,  and  in  all  breakages  of  vessels  containing  nitric  acid. 

The  prevention  of  accidents  and  diseases  among  workmen  in 
chemical  and  metallurgical  plants  is  a  subject  which  has  received 
much  consideration  in  England  and  Germany.  From  the  experience 
in  those  countries  we  may  conclude  that  the  following  preventive 
measures  may  be  taken: — 

1.  In  petroleum  refineries,  extraction  rooms,  ether  manufactories, 
plants  where  inflammable  liquids  and  vapors  are  likely  to  be  present 
in  the  air,  flour  mills,  and  all  other  mills  where  inflammable  dusts 
are  likely  to  be  wafted  about  or  suspended  in  the  air,  the  belts  on 
all  machinery  should  be  treated  with  a  suitable  compound  to  pre- 
vent or  minimize  the  possibility  of  static  discharges.     The  other 
measures  necessary  for  minimizing  the  fire  risks  are  well  known. 

2.  Workmen  in  plants  wherein  the  air  is  contaminated  with  halo- 
gen, mineral  acid,  metal  or  other  irritating  vapor,  should  be  re- 
quired to  wear  "workmen-respirators". 

3.  Instructions  should  be  given  as  to  the  use  of  oxygen  and  the 
methods  of  effecting  artificial  respiration.    A  very  good  description 
of  such  procedures  is  given  in  the  Chemical  Trade  Journal,  1896,  v. 
19:  260. 

4.  Glasses  for  the  protection  of  the  eyes  of  workmen  should  be 
required  in  plants  where  acids  or  caustic  liquids  are  used  or  made. 

5.  The  plants  should  be  well  ventilated,  in  order  to  prevent  the 
accumulation  of  gases  and  vapors. 

A  number  of  safety  devices  have  been  invented  in  Europe  for 
workmen  in  chemical  plants,  and  many  of  them  have  been  found  to 
be  of  great  value.  These  cannot  be  considered  here.  It  has  also 
been  statistically  shown  that  a  great  many  of  the  accidents  in  chemi- 
cal plants  happen  on  Mondays. 


Air  Impurities — Dusts,  Fumes,  and  Gases  311 

While  we  have  not  given  as  much  attention  in  this  country  as  we 
might  to  the  subject  of  dusts,  fumes,  and  gases  in  industrial  establish- 
ments, the  writer  knows  of  earnest  efforts  on  the  part  of  certain 
large  corporations  to  provide  every  precaution.  One  of  the  most 
difficult  phases  of  the  problem  here  is  to  secure  the  cooperation  of 
the  non-English  speaking  laborers.  The  American's  appraisal  of  the 
value  of  a  Dago's  life,  however,  is  associated  not  only  with  questions 
of  financial  economy,  but  also  with  the  problem  of  how  best  to  pre- 
serve the  economic  efficiency  (health)  of  the  individual.  Preven- 
tion, reduction,  and  recovery  are,  therefore,  of  great  importance  as 
public  health  problems.  Legislation  is  needed,  but  laws  do  not 
either  enact  or  execute  themselves  and  we  must  have  sufficient  ap- 
propriations for  the  determination  of  facts  and  the  enlightenment  of 
the  public  mind  as  to  the  effects  of  noxious  industrial  emanations. 


EFFECTS  OF  CONFINED  AIR  UPON  THE 
HEALTH  OF  WORKERS 


GEORGE  M.  PRICE 
New  York  State  Factory  Investigating  Commission. 


The  air  conditions  in  industrial  establishments,  which  have  an 
effect  upon  the  health  of  the  workers,  may  be  classified  in  three 
divisions:  (i)  extreme  variations  in  pressure,  humidity  and  tempera- 
ture; (2)  dusts,  poisons,  gases,  fumes,  and  infective  bacteria;  and 
(3)  ordinary  confined  air.  Of  these  three  divisions  the  first  two 
may  be  regarded  as  accidental  to  industries.  The  third  division,  or- 
dinary confined  air,  is  practically  incidental  to  all  indoor  industries. 
The  relative  number  of  industries  in  which  there  is  considerable 
variation  in  pressure,  humidity,  and  temperature,  or  in  which  there 
is  considerable  danger  from  dust,  poisons,  gases,  and  fumes,  is  small 
in  comparison  with  the  industries  in  the  establishments  of  which 
confined  air  prevails. 

By  the  term  "confined  air"  is  meant  air  which  is  confined  and 
vitiated  by  many  impurities  due  to  respiration,  combustion,  illumi- 
nation, and  overcrowding.  In  an  examination  of  4,850  establish- 
ments in  New  York  State  no  means  of  ventilation,  except  by  win- 
dows, was  found  in  88  per  cent  of  the  shops.  The  air  in  all  these 
shops  was  confined  and  vitiated. 

There  is  as  yet  a  difference  of  opinion  as  to  the  exact  nature  of 
the  toxicity  of  confined  air.  There  is,  however,  no  difference  of  opin- 
ion as  to  the  dangers  to  health  of  a  continuous  and  constant  inhala- 
tion of  such  air. 

It  is  not  difficult  to  study  the  effects  of  extreme  variations  of 
pressure,  temperature,  and  humidity  of  the  air  upon  the  health  of 
workers  in  factories.  Nor  is  it  very  difficult  to  trace  the  effects  of 
specific  poisons,  gases,  or  fumes  in  the  air,  or  to  study  the  results 
of  constant  inhalation  of  certain  kinds  of  dusts.  The  etiological  re- 
lations between  the  accidental  air  impurities  and  the  health  of 
workers  may  be  studied  experimentally  as  well  as  clinically.  The 
pathological  lesions  produced  by  most  of  these  accidental  impurities 


Effects  of  Confined  Air  Upon  Health  of  Workers        313 

are  distinct  and  certain,  and  the  diseases  produced  by  them  are  either 
acute  or  chronic. 

Not  so  with  the  effect  of  ordinary  air  impurities,  which  are  under- 
stood by  the  term  "confined  air".  The  effects  of  confined  air  are 
less  distinct,  more  difficult  to  prove,  less  direct,  and  more  insidious, 
although  not  less  deadly.  Mortality  statistics  show  that  the  death 
rate  of  workers  in  indoor  occupations  is  much  higher  than  that  of 
workers  in  outdoor  occupations.  There  is  no  doubt  that  the  chief 
cause  of  this  higher  rate  of  mortality  among  indoor  workers  is  the 
confined  air  of  shops  and  factories.  Aside  from  this,  however,  we 
have  hardly  any  evidence  in  mortality  statistics  as  to  the  effects  of 
confined  air  upon  workers.  Confined  air  does  not  produce  distinct 
pathological  lesions,  nor  does  it  directly  cause  any  diseased  condi- 
tions; and  therefore  its  influence  on  the  death  rate  is  difficult  to 
prove.  The  best  method  for  studying  the  effects  of  confined  air 
upon  the  health  of  workers  is  to  study  the  comparative  morbidity 
rates  of  workers  in  different  occupations  who  habitually  breathe 
stale  air  in  the  course  of  their  several  employments. 

The  effects  of  constant  and  continuous  inhalation  by  workers  of 
the  vitiated  atmosphere  of  shop  or  factory  will  undoubtedly  manifest 
themselves  upon  the  general  health  of  the  workers,  but  more  imme- 
diately and  directly  in  the  organs  of  respiration  and  digestion. 
Lassitude,  fatigue,  headaches,  anorexia,  anemia,  indigestion,  defec- 
tive oxygenation,  lack  of  vital  resistance,  and  a  predisposition  to 
catarrhal  affections  of  the  air  passages,  are  the  inevitable  results  of 
a  chronic  intoxication  by  vitiated  air. 

The  diseases,  therefore,  which  we  would  expect  to  find  among 
workers  in  vitiated  atmospheres  are  bronchitis,  anemia,  and  indi- 
gestion. Pulmonary  tuberculosis  and  diseases  of  metabolism  would 
probably  be  the  sequelae. 

In  the  effort  to  determine  the  effects  of  confined  air  upon  workers 
it  would  be  valuable  to  have  a  comparative  table  of  the  prevalence 
of  anemia,  bronchitis,  and  digestive  diseases  among  workers  in  vari- 
ous indoor  occupations.  Unfortunately  such  data  are  unavailable  in 
this  country.  The  only  way  by  which  the  facts  may  be  gathered  is 
by  a  physical  examination  of  a  large  number  of  workers  in  different 
trades.  It  has,  therefore,  occurred  to  me  that  it  may  be  of  value 
to  present  some  results  of  a  physical  examination  of  workers  in 


314  American  Labor  Legislation  Review 

two   different   industries,   which   it   was   my  privilege   to  conduct 
during  the  last  year. 

The  medical  examination  of  eight  hundred  bakers  was  made  dur- 
ing last  October  by  the  New  York  State  Factory  Investigating  Com- 
mission. The  medical  examination  of  six  hundred  cloak  and  suit 
makers  was  made  by  the  Joint  Board  of  Sanitary  Control  in  the 
Cloak,  Suit  and  Skirt  Industry  during  the  month  of  March.  The 
bakers  examined  were  those  found  in  cellar  bakeries  in  New  York 
City;  the  tailors  examined  were  those  found  in  some  .of  the  best 
shops  in  the  same  city.  We  have  also  examined  six  hundred  tailors 
in  the  worst  shops  in  the  East  Side  of  New  York  City,  but  data  for 
these  are  still  unavailable.  The  accompanying  table  is  very  incom- 
plete and  no  classification  has  been  made  according  to  age  and  sex. 

The  nativity  and  personnel  of  the  bakers  and  tailors  examined 
differed  very  little;  their  hours  of  labor  were  but  slightly  different 
though  somewhat  to  the  advantage  of  the  tailors ;  night  work  is,  of 
course,  customary  in  bread  making  although  a  negligible  factor  in 
tailoring. 

Dust  was  found  in  bakeries  as  well  as  in  tailor  shops.  With  the 
present  methods  of  baking,  however,  the  effect  of  the  flour  dust  is 
unimportant  as  very  little  is  allowed  to  escape.  The  vegetable  and 
animal  dust  found  in  cloak  shops  was  not  sufficient  in  quantity  to 
cause  serious  injuries.  In  the  bakeries  the  temperatures  near  the 
ovens  were  rather  high,  but  this  affected  only  a  comparatively  small 
number  of  workers.  The  amount  of  CO2  in  bakeries  and  cloak 
shops  does  not  differ  very  much.  According  to  Dr.  C.  T.  Graham- 
Rogers,  who  has  made  examinations  in  the  shops  of  both  industries, 
the  amount  of  CO2  in  the  air  ranges  from  6  to  25  per  10,000  vol- 
umes, and  does  not  differ  very  much  in  the  two  industries. 

The  sanitary  conditions  of  the  cloak  shops  in  which  workers 
have  been  examined  were  exceptionally  good,  as  these  belonged  to 
certificated  shops  in  the  industry.  All  the  cloak  shops  examined 
were  ventilated,  however,  by  means  of  ordinary  windows  and, 
although  not  overcrowded,  the  ventilation  of  all  the  rooms  was  de- 
fective because  the  windows  were  closed  and  no  special  provision 
was  made  for  introducing  fresh  air.  The  bakeries  examined  were 
all  underground  with  no  provision  for  ventilation  except  through 
small  windows  or  gratings,  but  owing  to  the  heated  ovens  the  change 
of  air  was  probably  not  less  than  in  the  tailor  shops. 


Effects  of  Confined  Air  Upon  Health  of  Workers        315 

RESULTS    OF    THE    PHYSICAL    EXAMINATION    OF     1413    WORKERS     IN 
CELLAR  BAKERIES  AND  IN   SOME  OF  THE  BEST  TAILOR 

SHOPS  IN  NEW  YORK  CITY 

BAKERS  TAILORS 

No.  Per  cent  No.  Per  cent 

Total  examined                          800         100.0  613         100.0 

Free  from  disease                                347          43.4  115           18.8 
Had  the  following  diseases: 

Anemia                                            183          22.9  I581          25.8 

Asthma                                            21            2.6  9*           1.5 

....     |  Acute  177          22.1  i93  3.1 

Bronchitis  1    _ 

(  Chronic  36*  5.9 

Laryngitis  55  0.8 

Pleurisy  2  0.3  4°  0.7 

™  ,         1     •     (    Positive  19  2.4  4  0.7 

Tuberculosis  <   _  ' 

(  Suspected  f  1.2 

Diseases  of  the  digestive  system  76  9.5         186          30.3 

JOf  the  158  who  had  anemia  only  31  had  no  other  disease;  of  the  186 
who  had  diseases  of  the  digestive  system  only  36  had  no  other  disease; 
the  others  had  one,  or  more  than  one,  other  disease. 

3  Five  of  these  had  chronic  bronchitis  and  are  included  in  that  list. 

"One  of  these  had  tonsilitis  and  is  included  under  diseases  of  the  diges- 
tive system. 

4  One  of  these  had  pharyngitis  and  is  included  under  diseases  of  the 
digestive  system. 

5  One  of  these  had  chronic  bronchitis  and  is  included  in  that  list. 
"Two  of  these  had  chronic  bronchitis  and  are  included  in  that  list. 
TA11  of  these  had  chronic  bronchitis  and  are  included  in  that  list. 


Total  number  of  diseases  among  the  tailors,  about  950. 
Total  number  of  tailors,  613. 
Ratio  of  diseases  to  tailors,  15.5:10. 


316  American  Labor  Legislation  Review 

We  have  no  statistics  in  this  country  with  which  to  compare  the 
results  obtained  by  our  physical  examination.  We  thus  have  no 
standard  by  which  to  judge  the  variations  in  the  morbidity  rate. 
Nor  can  a  comparison  be  made  with  the  morbidity  statistics  of 
Sommerfeld  and  others  gathered  from  the  German  sick  funds 
(Krankenkassen) ,  for  the  reason  that  these  morbidity  rates  are  giv- 
en mostly  for  those  members  of  the  sick-fund  societies  who  are 
unable  to  work.  Dr.  Sidney  I.  Schwab's  figures  of  the  preval- 
ence of  neurasthenia  among  tailors,8  and  Dr.  Waters'  claim  of  the 
large  percentage  of  tuberculosis  among  tailors,  may  be  referred  to 
here  as  the  only  figures  available  on  the  morbidity  of  tailors. 

The  standard  mentioned  by  Hoffman  of  the  incidence  of  15.5  dis- 
eases to  ten  persons,  being  the  German  rate,  can  be  compared  to 
the  950  diseases  for  the  613  tailors  examined,  which  makes  a 
ratio  of  15.5  to  10. 

The  large  number  of  bakers  suffering  from  bronchitis,  in  com- 
parison with  the  number  of  tailors  suffering  from  that  disease, 
seems  to  indicate  the  better  sanitary  conditions  of  the  tailor  shops, 
which,  as  has  been  noted  above,  belong  to  those  that  have  received 
sanitary  certificates  from  the  Joint  Board  of  Sanitary  Control. 
On  the  other  hand,  the  comparatively  large  number  of  digestive 
diseases  among  tailors  may  perhaps  be  due  to  their  stooping  pos- 
ture and  to  their  lesser  muscular  activity  as  compared  with  bakers, 
who  are  always  on  their  feet  and  who  change  the  character  of 
their  work  a  number  of  times  during  the  day,  while  tailors  sit  at 
a  machine  for  nine  hours  a  day  with  only  a  single  interval  for 
relaxation. 

It  seems  to  me  that  the  comparatively  high  percentage  of  anemia, 
bronchitis,  and  digestive  diseases  noted  among  both  the  bakers 
and  the  tailors  is  at  least  suggestive  of  the  defective  ventilation 
of  the  shops  in  these  industries,  and  that  the  confined  air  which  bak- 
ers and  tailors  are  compelled  to  breathe  habitually  has  a  strong  etio- 
logical  relation  to  these  diseases.  Much  more  intensive  and  exten- 
sive study  of  the  subject  is  necessary,  however,  before  the  relation 
of  confined  air  to  the  health  of  the  workers  can  be  definitely  deter- 
mined. 

"  Publication  No.  12,  American  Association  for  Labor  Legislation. 


GENERAL  DISCUSSION 

MR.  J.  T.  AINSLIE  WALKER,  New  York  City:  I  have  listened  with 
great  interest  to  the  papers  read  this  afternoon.  Speaking  as  an 
Englishman,  having  been  in  this  country  but  a  few  months,  there 
is  one  phase  of  this  problem  which  you  do  not  consider  as  fully  as 
I  had  hoped.  We  have  heard  of  the  precautions  to  secure  proper 
ventilation,  but  the  last  speaker  has  dashed  our  hopes  by  stating 
that  in  many  instances  among  tailors  and  bakers  confined  air  is  al- 
most essential.  To  consider  ventilation  alone  is  not  enough ;  we 
must  deal  with  the  presence  of  dust  on  all  workroom  floors.  This 
problem  has  received  attention  at  home  and  I  hope  soon  to  see  it 
properly  handled  in  this  country.  I  know  of  no  finer  institution 
to  take  up  such  work  than  this  Association. 

I  think  we  all  agree,  also,  that  if  this  problem  is  to  receive  proper 
attention  we  must  have  the  assistance  of  the  manufacturers.  There 
is  no  use  in  trying  to  force  them  to  do  what  we  want,  but  we  must 
try  to  persuade  them.  If  the  moral  argument  is  not  sufficient, 
the  best  inducement  is  the  one  that  appeals  to  the  pocketbook.  The 
best  that  a  man  can  do  in  a  day  is  one  hundred  units  of  work.  Sup- 
pose a  manufacturer  is  employing  one  hundred  workmen.  If  you 
represent  to  him  that,  by  neglecting  certain  precautions  which  you 
can  show  him  how  to  handle  successfully  and  economically,  the  loss 
of  work  and  fall  in  efficiency  is  ten  per  cent,  you  have  a  direct  ar- 
gument to  place  before  him.  He  sees  that  among  one  hundred 
workers  a  lowering  of  ten  per  cent  in  efficiency  means  that  he  is 
losing  the  work  of  ten  able-bodied  men  every  day.  If  this  argu- 
ment is  put  before  the  American  manufacturer,  as  it  has  been  suc- 
cessfully put  before  the  English  manufacturer,  I  think  he  will 
listen  to  you.  You  are  more  likely  to  achieve  success  this  way  than 
if  you  appeal  from  a  moral  point  of  view. 

A  year  or  two  ago  an  English  doctor,  bearing  the  famous  name 
of  Lister,  called  attention  to  the  high  death  rate  among  printers. 
The  attention  of  the  federation  of  printers  and  allied  trades  was 
called  to  it  by  myself,  and  they  decided  to  investigate  the  question 
first-hand.  A  certain  area  of  floor  space  in  one  of  the  largest  es- 
tablishments in  London  was  chalked  off.  One-half  was  sprinkled 
with  a  disinfection  solution;  the  other  half  was  sprinkled  with 


318  American  Labor  Legislation  Revieu) 

water.  Swabs  were  taken  over  each  of  these  spaces  and  the  con- 
tents examined.  On  the  plate  which  was  from  the  section  sprinkled 
with  water  only  there  were  crowds  of  bacteria;  the  other  plate 
showed  no  colony  of  bacteria.  Thus  the  disinfection  was  shown  to 
be  satisfactory.  The  publication  of  this  result  in  the  textile  papers 
and  trade  journals  had  a  marked  effect  on  the  minds  of  manufac- 
turers in  England. 

MR.  MEHREN,  New  York  City:  We  are  engaged  in  efficiency  en- 
gineering work,  the  improvement  of  factory  conditions  in  order  that 
the  output  may  be  the  maximum  and  that  the  manufacturer  may 
have  the  least  possible  cost  and  the  worker  the  highest  wage.  From 
that  standpoint  the  efficiency  of  the  men  is  a  very  important  con- 
sideration. We  go  to  the  manufacturer  and  say,  "Betterment  works 
of  all  sorts  are  not  philanthropies ;  they  are  profitable  investments." 
We  have  not  gone  into  chemical  factories  and  consequently  much 
said  this  morning  about  the  lead  industry  went  over  my  head,  but 
we  have  been  able  to  make  valuable  use  of  efficiency  tests.  We  found 
a  short  time  ago  a  large  establishment  with  fifteen  hundred  em- 
ployees in  which  the  manufacturers  knew  they  had  not  full  effi- 
ciency, although  they  had  not  been  able  to  put  their  finger  on  the 
cause.  We  found  that  the  ventilation  was  bad  and  that  the  common 
drinking  cup  had  propagated  colds  in  winter.  Why  not  call  in  to 
aid  the  campaign  for  industrial  hygiene  the  efficiency  engineer,  who 
is  directly  studying  factory  conditions  with  the  idea  of  improving 
them?  Legislation,  strict  enforcement  of  law,  will  produce  much 
good.  But  the  greatest  result  will  be  accomplished  when  you  take 
advantage  of  all  possible  methods,  one  of  which  is  to  enlist  the 
cooperation  of  the  consultant  in  the  engineering  world. 

DR.  LEONARD  W.  HATCH,  New  York  Department  of  Labor:  This 
point  has  come  to  my  attention  as  bearing  out  what  was  said  of  the 
value  to  the  manufacturer  of  medical  care  of  his  employees.  A 
certain  small  New  York  plant  employing  two  hundred  and  fifty 
people  is  quite  a  model  establishment  so  far  as  ventilation  goes. 
The  firm  established  a  benefit  system  and  in  connection  with  that 
a  plan  for  giving  the  employees  medical  attention.  It  was  arranged 
that  a  physician,  employed  by  the  firm,  should  be  at  the  plant  every 
day  at  five  o'clock,  and  anyone  who  was  employed  there  could  con- 


General  Discussion  319 

suit  the  physician  by  making  his  desire  known  to  the  watchman  or 
porter.  At  five  o'clock  all  who  could  be  attended  to  that  day  were 
notified  by  the  watchman.  After  a  year's  experience  the  head  of  the 
firm  stated  that,  though  they  had  never  kept  records  of  the  time  lost 
in  previous  years,  he  was  sure  that,  even  in  that  period,  without  any 
special  hazards,  they  had  saved  enough  of  the  workers'  time  to  more 
than  pay  the  cost. 

MR.  PAUL  KENNADAY,  Secretary,  New  York  Association  for 
Labor  Legislation,  New  York  City:  We  have  heard  that  it  pays  to 
keep  the  workmen  well.  In  this  Association  we  want  to  take  the 
view  that  it  is  just  to  keep  the  workmen  well.  We  should  go  to  the 
labor  unions,  get  out  on  the  stump,  use  the  newspapers,  and  teach 
the  industrial  population  that  they  should  keep  themselves  well  for 
their  own  benefit  and  not  to  increase  any  dividends.  And  then, 
having  aroused  that  feeling  among  them  and  a  certain  amount  of 
enthusiasm,  we  should  get  after  our  state  labor  departments  and  get 
them  to  do  their  duty.  Many  are  doing  excellent  work  and  many 
are  not  doing  anything  at  all.  They  should  make  investigations 
into  continuous  processes,  and  give  us  the  facts  in  regard  to  the 
number  of  men  who  are  working  seven  days  a  week  and  the  effect 
of  such  work  on  their  health.  At  present  we  have  no  such  facts.  As 
one  member  of  the  Association  I  say,  let  us  emphasize  a  little 
more  strongly  the  fact  that  it  is  justice  we  are  after  and  not  the 
payment  of  higher  dividends. 

DR.  LEE  K.  FRANKEL,  Neiv  York  City:  I  have  been  reminded 
of  an  old  story  about  barking  dogs  that  never  bite.  I  suppose  you 
know  the  story  of  the  man  who  was  running  away  from  a  dog. 
His  friends  told  him,  "Barking  dogs  never  bite."  But  the  man  re- 
plied, "You  know  it  and  I  know  it,  but  the  dog  doesn't  know  it." 

The  discussion  here  has  centered  largely  around  what  might  be 
done  in  the  direction  of  preventing  disease  through  efficient  legis- 
lation and  by  the  employer  of  labor,  but  nothing  has  been  said  about 
what  can  be  done  by  the  workman  toward  safeguarding  his  own 
health.  I  want  to  mention  what  has  been  done  in  the  city  of  Vienna, 
where  there  is  a  federation  of  sick  clubs,  under  the  Austrian  govern- 
ment, which  records  every  disease  that  occurs  among  its  members, 
and  these  clubs  practically  comprise  every  workman  earning  a  cer- 


320  American  Labor  Legislation  Review 

tain  income.  Every  member  realizes  that  it  is  for  his  distinct  ad- 
vantage to  report  the  conditions  that  exist  in  the  factory  where  he 
works,  particularly  with  reference  to  accidents.  The  result  is  that 
in  the  central  bureau  there  is  a  careful  record  of  every  industrial 
establishment  in  the  city  of  Vienna  reported  under  the  very  best 
form  of  factory  inspection  known,  namely  by  the  employee  himself, 
and  by  moral  suasion  without  the  necessity  of  legislation.  These 
clubs  have  gone  to  the  employer  who  has  not  introduced  proper 
safeguards  against  accidents,  or  who  has  not  put  his  mill  or  factory 
in  good  sanitary  order,  and  have  shown  him  that  his  establishment 
is  below  the  standard,  or  proved  to  him  that  more  accidents  occur 
in  his  establishment  than  in  those  of  his  competitors.  By  this  method 
they  have  been  able  to  raise  the  standard  exceedingly.  Lacking 
compulsory  industrial  insurance  it  seems  to  me  that,  if  this  problem 
were  taken  up  by  our  labor  organizations,  they  could  institute  a  sys- 
tem similar  to  that  in  vogue  in  Vienna  and  bring  home  to  their 
employers  the  need  for  putting  their  factories  in  proper  condition. 

MR.  MILES  M.  DAWSON,  New  York  City:  There  is  no  question  in 
my  mind  but  that  wherever  there  is  a  system  of  insurance,  con- 
tributed to  by  both  employer  and  employee,  in  addition  to  the  col- 
lection of  reliable  information,  there  is  the  further  result  that  at- 
tention is  given  to  the  subject  by  both  sides.  The  benefits  of  sick- 
ness insurance  in  guarding  the  health  of  employees  in  Germany  are 
doubtless  great.  This  has  reference  quite  as  much  to  accidents 
as  to  illness.  It  is,  therefore,  unfortunate  that  so  far,  during  the 
brief  development  we  have  had  of  workmen's  compensation  in  this 
country,  there  has  been  no  extension  of  such  insurance.  We  would 
not  only  have  done  better  work  in  connection  with  workmen's  com- 
pensation, but  would  have  indirectly  had  means  of  determining  what 
the  facts  are  concerning  industrial  diseases  and  industrial  accidents, 
if  we  had  adopted  the  plan  in  force  in  many  countries  of  sickness 
insurance  societies. 

MR.  JOHN  MARTIN,  New  York  City:  Professor  Winslow  said, 
and  so  far  as  I  have  been  able  to  read  the  literature  on  the  subject 
it  seems  to  be  agreed,  that  practically  the  only  factor  in  ventilation 
about  which  we  are  positive  is  that  overheating  is  detrimental  to 
health  and  vigor.  He  went  on  to  argue  that  that  was  a  sufficient 


General  Discussion  321 

reason  for  declaring  in  favor  of  an  artificial  system  of  ventilation ; 
because,  he  said,  if  your  factory  or  schoolroom  is  overheated,  evi- 
dently the  thing  to  do  is  to  force  in  air,  but  it  must  not  be  below 
60°  F.  when  it  enters.  That  logic,  which  I  think  is  commonly  enun- 
ciated by  ventilating  engineers,  seems  to  me  defective.  If  the  fac- 
tory or  schoolroom  is  overheated,  the  common-sense,  obvious 
remedy  is  to  turn  off  the  steam  and  reduce  the  heating  surfaces. 

As  a  matter  of  fact  in  this  country  we  have  for  some  years  been 
convinced  of  the  desirability  of  having  rooms  occupied  by  human 
beings,  particularly  hotels,  trains,  factories,  and  schools,  kept  at 
something  above  the  outside  temperature  in  winter  and,  with  a  na- 
tional tendency  to  overemphasis  and  exaggeration,  we  have  gone  to 
the  length  of  making  about  75°  or  80°  F.  the  standard  indoor  tem- 
perature in  wintertime.  Manufacturers  and  school  authorities  are 
literally  killing  with  kindness.  We  have  installed  elaborate  heating 
apparatus,  and  we  use  up  coal  in  the  most  lavish  manner,  with  the 
result  that  we  are  creating  greater  loss  than  we  are  avoiding.  Now 
the  remedy  for  that,  it  would  appear,  is  not  to  discard  heating 
apparatus  but  to  install  another  apparatus  to  offset  the  one  you 
have  already  installed.  Surely  the  manufacturer  might  more  rea- 
sonably be  told,  "You  can  save  your  earlier  expense;  you  need  not 
install  so  many  radiators ;  you  are  damaging  your  employees,  as  we 
are  damaging  our  school  children,  by  this  mistaken  kindness."  To 
my  mind,  the  thing  to  do  is  to  teach  the  employees  to  throw  the 
windows  open. 

MRS.  IRENE  OSGOOD  ANDREWS,  New  York  City:  I  want  to  say 
a  word  as  to  the  relative  value  of  protection  from  bad  ventilation 
and  protection  from  disease.  Ventilation  is  a  much  bigger  problem 
and  covers  a  larger  number  of  persons,  and  we  should  be  delighted 
to  know  what  to  do  about  it.  We  knew,  after  some  study,  what 
was  an  effective  remedy  for  phosphorus  poisoning;  we  knew  after 
a  while  about  compressed-air  illness,  about  lead  poisoning,  and  some- 
thing about  blindness  from  wood-alcohol ;  but  we  don't  know  what 
to  do  about  ventilation.  Illinois  passed  in  1909  perhaps  the  most 
effective  law,  yet  I  am  told  that  it  is  only  indifferently  enforced. 
The  occupational  disease  law  passed  last  year  has  met  with  greater 
success.  Massachusetts  has  had  medical  inspection  of  factories  for 
six  years,  but  Massachusetts  has  no  standard  for  ventilation.  New 


322  American  Labor  Legislation  Review 

York  has  had  medical  inspection  for  four  years,  but  has  no  standard 
for  ventilation.  Those  of  you  who  are  familiar  with  New  York 
conditions  know  that  for  three  years  we  have  been  having  confer- 
ences on  ventilation.  Last  year  a  bill  was  proposed  and  this  year 
the  experts  disagreed  entirely  and  the  bill  was  cast  out.  Anyone 
who  can  give  us  information  on  how  to  handle  effectively  and  en- 
forcibly  this  subject  of  ventilation  awaits  a  place  in  the  hall  of 
fame.  We  hoped  that  might  be  one  outcome  of  the  meeting  here. 

Dr.  Frankel  has  told  us  what  the  workman  can  do.  Austria  has 
been  behind  other  foreign  countries.  But,  as  an  illustration  of  its 
recent  progress,  although  fourteen  countries  have  prohibited  the 
night  work  of  women,  the  period  of  rest  being  between  ten  at  night 
and  five  in  the  morning,  Austria  has  now  taken  the  advanced  stand 
that  the  rest  period  is  to  come  between  eight  at  night  and  five  in  the 
morning.  Before  we  can  expect  much  of  the  workman  we  must 
have  a  strong  body  of  labor  law  back  of  what  we  expect  him  to  do. 
I  see  no  reason  why  the  conditions  which  Mr.  Pratt  showed  us  this 
morning  in  his  pictures  of  lead  poisoning  should  not  be  removed 
before  we  ask  the  workman  to  protect  himself.  I  think  that  must  be 
the  line  of  progress  in  this  country. 

DR.  C.  T.  GRAHAM-ROGERS,  Medical  Inspector  of  Factories,  New 
York:  I  think  the  subject  of  ventilation  has  been  pretty  well  covered 
by  those  who  have  discussed  it,  and  I  do  not  feel  that  I  can  add 
much.  It  is  true  that  experts  on  ventilation,  instead  of  agreeing, 
have  disagreed,  and  that  the  whole  subject  is  in  rather  a  chaotic  state, 
probably  because  there  has  not  been  strong  enough  cooperation  on 
the  part  of  engineers,  physiologists,  medical  men,  and  factory  work- 
ers to  get  results.  There  are  so  many  factors  entering  into  the 
question  that  I  doubt  if  six  months  or  a  year  will  give  us  much  of  a 
clue  to  its  solution.  It  will  take  several  years  of  intensive  investiga- 
tion. But  we  cannot  have  any  standard  ventilation  for  all  indus- 
tries; each  industry  stands  by  itself  and  in  each  intensive  research 
must  be  pursued.  We  shall  get  results,  not  now,  but  in  the  future. 

PROFESSOR  C.-E.  A.  WINSLOW,  New  York  City:  I  hope  very  much 
that  this  Association  will  take  up  specifically  the  problem  of  venti- 
lation. If  the  Association  could  get  experts,  men  qualified  to  take 
up  these  problems,  it  would  mean  a  great  deal  of  work  and  time,  but 
the  results  would  be  of  great  value. 


General  Discussion  323 

I  face  the  logical  conclusion :  If  the  only  problem  is  overheating 
we  can  do  without  ventilation.  But  aside  from  the  heat  question  we 
have  to  change  the  air  in  order  to  remove  the  odors,  the  dust,  and 
the  fumes.  Whether  they  hurt  or  not  they  have  to  be  removed. 
And  we  have  to  have  tempered  air.  In  a  hospital  you  can  do  what 
you  want  with  patients,  but  in  a  factory  you  cannot  have  the  people 
making  complaints,  so  the  windows  have  to  be  shut,  and  I  doubt  if  it 
would  conduce  to  the  efficiency  of  the  industrial  worker  to  do  other- 
wise. 

MRS.  FLORENCE  KELLEY,  National  Consumers'  League,  New  York 
City:  One  point  has  not  been  clearly  brought  out  in  the  discus- 
sion of  poisonous  trades  and  occupations.  We  were  shown  this 
morning  pictures  of  common  laborers  shoveling  lead,  filling  the  air 
with  dust  in  its  most  poisonous  forms,  for  themselves  and  for  every- 
body else  to  breathe,  and  to  my  lay  mind  it  was  a  most  horrifying 
spectacle.  I  do  not  know  much  about  it,  but  I  had  not  had  a  con- 
ception that  there  were  men  who  would  do  such  work,  especially 
when  it  is  not  necessary  in  this  or  any  other  country.  Would  it 
not  be  possible  to  have  the  officials  of  a  state  where  the  lead  industry 
is  carried  on  publish  the  pictures  and  an  explanation  of  apparatus 
in  use  by  standard  concerns,  which  eliminates  the  poisonous  process, 
so  the  workman  could  be  intelligent  in  his  choice  of  occupations? 
Could  not  that  knowledge  be  spread  among  the  people  so  that  where 
there  is  in  actual  use  a  successful  mechanical  method  for  the  elim- 
ination of  poison  there  need  no  longer  be  any  excuse  for  the  primi- 
tive process? 

DR.  DAVID  L.  EDSALL,  Harvard  Medical  School,  Cambridge: 
There  is  one  thing  I  should  like  to  say  in  relation  to  a  subject  of 
which  Dr.  Cabot  spoke.  It  is  important  that  hospitals  keep  records 
and  that  physicians  be  trained.  The  hospital  records,  if  available, 
would  be  the  best  thing  we  could  have.  At  present  it  is  impossible 
to  get  any  satisfactory  facts  which  are  precise  enough  to  amount  to 
anything.  Except  a  careless  name  like  "laborer"  to  describe  a  dozen 
different  occupations,  we  find  nothing  to  indicate  what  a  man  is 
doing.  Hospital  physicians  need  to  be  urged  to  contribute  their 
share  to  the  solution  of  the  problem  of  industrial  diseases. 

Hospitals  should  also  have  exhibits  which  they  could  use  to  teach 


324  American  Labor  Legislation  Review 

the  patients  themselves  what  they  should  do.  Undoubtedly  one  of 
the  best  effects  of  the  German  insurance  laws  has  been  their  effect 
on  health,  and  one  of  the  most  important  ways  in  which  they  have 
affected  health  has  been  through  the  graphic  education  they  have 
given.  The  education  that  has  spread  among  the  people  as  to  right 
methods  of  living  has  been  one  of  the  most  advantageous  things  the 
country  has  had. 

The  hospital  must  be  looked  upon  as  one  of  the  centers  for  spread- 
ing information  in  regard  to  hygiene.  I  do  not  see  any  reason  why 
our  hospitals  should  not  spread  a  great  deal  more  information  than 
they  do  on  health  matters. 

DR.  WARREN  COLEMAN,  Chairman:  In  Bellevue  and  no  doubt  in 
the  larger  hospitals  of  the  country,  the  physicians  themselves  take 
little  or  no  part  in  acquiring  sociological  data  concerning  the  patient. 
At  Bellevue  we  have  our  bedside  card,  one  side  giving  the  sociolog- 
ical data  and  the  other  the  bedside  data.  The  sociological  data  is 
filled  out  in  the  lower  office  by  an  untrained  person.  That  could  be 
corrected,  but  they  are  not  disposed  to  pay  salaries  to  trained  per- 
sons for  that  character  of  work. 

Again,  there  is  no  nomenclature  to  which  we  can  turn  to  deter- 
mine what  a  man's  occupation  is.  A  committee  has  been  appointed 
for  the  purpose  of  getting  up  such  a  nomenclature.  It  will  be  a 
heavy  task,  but  in  the  course  of  perhaps  a  year  of  two  years  we 
shall  probably  have  some  such  thing.  Not  long  ago  a  young  man 
came  into  my  ward  as  a  patient.  He  was  sixteen  and  gave  his  occu- 
pation as  lithographer.  I  thought  I  would  cross-question  him  and 
find  out  just  what  he  did.  I  found  he  swept  the  floor  in  the  litho- 
graphing room  and  in  winter  swept  the  snow  off  the  sidewalk;  yet 
he  had  gone  down  on  our  records  as  a  lithographer.  There  are  many 
other  similar  points  to  which  I  could  refer. 

DR.  JOHN  B.  ANDREWS,  Secretary,  American  Association  for 
Labor  Legislation,  New  York  City:  The  medical  profession  can 
furnish  us  with  information  which  we  can  spread  broadcast  in  the 
form  of  leaflets  among  the  workers  and  employers.  Professor 
Thompson  of  New  York  has  prepared  a  leaflet  on  lead  poisoning 
which  he  has  been  using  in  his  hospital  work  and  from  which  he  is 
getting  interesting  results.  Why  cannot  that  plan  be  worked  out  in 
every  hospital? 


General  Discussion  325 

There  was  a  second  point  that  I  hoped  Dr.  Cabot  would  empha- 
size,— the  establishment  of  special  clinics  for  the  prevention  and 
cure  of  occupational  diseases.  We  have  such  a  splendid  illustration 
in  Milan,  where  they  have  three  buildings  with  hospital  wards,  lab- 
oratories, clinics,  etc.,  especially  devoted  to  this  subject.  I  hope  that 
within  the  next  ten  years  we  shall  have  in  this  country  half  a  dozen 
of  these  institutions.  It  may  be  necessary  to  begin  the  work  with 
general  hospitals  and  I  think  Dr.  Cabot  and  Dr.  Edsall  will  be  among 
the  first  men  to  superintend  such  plans.  We  must  have  medical  men 
with  the  tools  at  hand  working  all  the  time  supplying  information 
for  the  prevention  of  these  industrial  diseases. 


IV 
STATE  PROMOTION  OF  INDUSTRIAL  HYGIENE 


Presiding  Officer:  HENRY  W.  FARNAM 

Yale  University 
NEW  HAVEN,  CONNECTICUT 


EDUCATION  FOR  THE  PREVENTION  OF  INDUSTRIAL 

DISEASES 


M.   G.  OVERLOCK 

State  Inspector  of  Health,  Massachusetts. 


Standing  to-day  at  the  very  portals  of  a  vast  field  of  opportunity, 
I  can  see  stretched  before  me  a  decade  of  achievement  in  human 
efficiency  unparalleled  in  the  history  of  the  world.  Your  organiza- 
tion has  tilled  the  bare  edges  of  this  field,  and  the  fruits  of  its 
labor  has  attracted  the  attention  of  every  student  of  human  events. 
The  mighty  stride  of  our  industrial  and  commercial  America  is  the 
wonder  of  all  the  nations  of  the  earth.  And  the  superior  skill  of 
our  American  workmen  is  attested  by  the  fact  that,  although  the 
machines  of  the  American  Shoe  and  Machinery  Company  are  scat- 
tered throughout  Europe,  shoes  made  upon  the  same  machines  by 
American  workmen  are  still  eagerly  sought,  because  of  their  supe- 
rior finish  and  workmanship,  by  Europeans. 

The  maintenance  of  human  efficiency  at  its  highest  standard  must 
be  the  watchword  in  the  next  decade.  And,  if  kept  at  high-water 
mark,  it  will  rebound  to  the  credit,  satisfaction,  and  glory  of  those 
who  have  to  do  with  and  who  bring  about  the  application  of  tried 
and  found-true  principles  of  personal  hygiene  for  the  avoidance  of 
industrial  accident  and  industrial  disease.  The  prevention  of 
such  diseases  must  be  brought  about  by  a  systematic  course  of  edu- 
cation, with  the  cooperation  of  the  numerous  agencies  at  our  com- 
mand. These  agencies,  taken  in  the  order  in  which  in  my  judg- 
ment they  belong,  should  be :  first,  medical  colleges ;  second, 
industrial  clinics;  third,  industrial  hygiene  exhibits,  both  traveling 
exhibits  and  museums;  and  fourth,  publicity  by  means  of  lectures, 
leaflets,  and  posted  warnings.  Laws  drawn  up  for  the  protection 
of  working  people  from  disease  are  themselves,  moreover,  educa- 
tional, and  employers  can  do  much  to  assist  the  movement, 


330  American  Labor  Legislation  Review 

I.     MEDICAL  COLLEGES 

At  the  present  time  an  opportunity  presents  itself  to  the  medical 
colleges  of  this  country  which  is  most  opportune.  If  these  institu- 
tions of  learning  will  add  to  their  curriculum  a  department  for  the 
diagnosis  and  treatment  of  industrial  diseases,  they  may  be,  by  their 
cooperation  with  boards  of  health  and  bureaus  of  factory  inspection 
in  the  various  states  in  which  they  are  located,  a  potent  factor  in 
impressing  upon  the  different  legislative  bodies  the  need  for  proper 
health  legislation  and  for  proper  appropriations  to  carry  out  this 
work.  Medical  men  thus  trained,  reporting  all  industrial  diseases 
to  the  central  body  and  keeping  in  close  touch  with  the  boards  of 
health  and  bureaus  of  factory  inspection  in  different  states,  may 
by  this  cooperation  be  of  immense  value  to  that  great  army  of  work- 
ers whose  occupations  make  them  susceptible  to  industrial  diseases. 

What  is  the  legislation  necessary  to  bring  this  about?  To  my 
mind  the  system  under  which  we  are  working  in  the  state  of 
Massachusetts  should  be  in  vogue  in  every  state  in  the  union.  Every 
state  should  have  medical  men  as  state  inspectors  of  health,  working 
under  the  direction  of  a  state  board  of  health  or  bureau  of  factory 
inspection,  and  reporting  their  findings  to  the  central  health  author- 
ity. It  is  my  candid  opinion,  and  I  feel  that  it  is  also  the  opinion 
of  the  physicians  generally  throughout  Massachusetts,  that  the  act 
creating  the  state  inspectors  of  health  and  setting  forth  their  duties 
was  a  most  important  legislative  action.  For  it  is  well  to  remember 
that  they  are  the  only  large  body  of  physicians  on  this  continent  who, 
acting  in  the  capacity  of  state  health  officials,  study  the  health,  in- 
cluding the  moral,  social,  and  physical  habits  of  the  people,  within 
and  without  the  factory.  Their  investigations  include,  among 
other  things,  an  inquiry  into  cleanliness,  ventilation,  the  condition  of 
the  air,  eyestrain,  temperature,  artificial  moisture,  the  proper 
removal  of  dust,  a  proper  system  of  lighting  to  avoid  injury  to  the 
eye,  pure  drinking  water,  receptacles  for  expectoration,  excessive 
humidity  in  textile  industries,  exposure  to  extreme  heat  in  laundries 
and  foundries,  and  exposure  to  lead  and  other  industrial  poisons, — 
in  fact,  a  scientific  study  with  a  view  to  the  elimination  of  all 
causes  which  lead  to  industrial  disease.  Those  of  us  in  the  field 
feel  that  we  are  working  under  the  direction  and  careful  scrutiny 
of  those  who  have  made  the  prevention  of  disease  their  life  study 
and  who  are  ever  willing  and  anxious,  so  far  as  the  means  at  their 


Education  for  the  Prevention  of  Industrial  Diseases        331 

command  will  allow,  to  make  scientific  application  of  every  health 
principle. 

I  believe  that  the  emulation  by  every  state  in  the  union  of  the 
methods  now  in  vogue  in  the  state  of  Massachusetts  will,  within  a 
decade,  produce  results  of  which  this  nation  may  be  justly  proud. 
Then,  as  I  said  in  the  beginning,  the  medical  colleges,  by  their  co- 
operation with  the  state  boards  of  health  and  bureaus  of  factory 
inspection,  could  with  profit  to  themselves  and  to  the  community 
and  the  state,  turn  out  men  whose  training  would  aid  greatly  in  the 
reduction  of  industrial  diseases.  Because  it  is  plain  that  these 
colleges,  using  the  deductions  made  from  the  experience  of  the  state 
health  officers  in  the  field,  would  be  working  on  facts  and  not  on 
theories. 

II.     INDUSTRIAL  CLINICS 

The  results  and  experience  at  Milan,  Italy,  and  the  opinion  of 
medical  men  who  have  followed  this  clinic  and  its  workings  show, 
I  believe,  that  we  should  have  an  industrial  clinic  in  each  of  the 
large  industrial  centers  of  the  United  States.  This  seems  to  me  an 
excellent  opportunity  for  our  philanthropists,  but  it  could  also,  in 
my  judgment,  be  taken  up  with  benefit  and  propriety  by  the  United 
States  government.  The  money  thus  spent  would  make  for  effi- 
ciency in  our  industrial  life,  would  be  conducive  to  a  greater  de- 
gree of  health  among  the  industrial  classes,  and  would  be  of  ines- 
timable value  to  the  millions  yet  unborn.  I  therefore  suggest  that 
the  Association  for  Labor  Legislation,  by  the  appointment  of  a 
proper  committee,  take  this  matter  under  advisement. 

III.     INDUSTRIAL  HYGIENE  EXHIBITS 

As  I  said  in  the  beginning,  this  campaign  for  the  betterment  of 
the  condition  of  the  man  or  woman  who  works,  to  be  efficient  and 
far-reaching,  must  necessarily  be  a  campaign  of  education.  I  feel 
sure  that  you  will  agree  with  me  that  the  traveling  exhibits,  particu- 
larly those  which  have  been  sent  out  by  the  Boston  Association  for 
the  Prevention  of  Tuberculosis,  as  well  as  those  from  other  cities 
and  states,  have  been  of  immense  educational  value  and  have  left  a 
strong  impression  upon  the  lay  mind,  as  well  as  upon  the  minds  of 
members  of  the  medical  profession  and  of  social  workers, — in  fact 
of  all  who  visited  these  different  exhibits.  It  would  seem  to  me  that 
we  might  establish  an  industrial  hygiene  exhibit  which  could  be 


332  American  Labor  Legislation  Review 

sent  from  city  to  city  and  which  would  have  a  stimulating  influence 
upon  those  at  the  head  of  industrial  establishments,  who  have  an 
opportunity  to  provide  sanitary  conditions  in  modern  up-to-date 
factories.  It  would  also  bring  to  the  laboring  man  the  realization 
that,  after  all,  the  scientific  application  of  the  principles  of  sanitation 
and  hygiene  are  being  worked  out  for  the  betterment  of  the  working 
class. 

Such  an  exhibit  would  have  another  effect.  It  would  ask  a 
question  of  the  landlord  who  is  renting  insanitary  and  ill-kept  dwell- 
ings to  the  working  classes.  This  question  in  substance  is:  If  the 
manufacturer  furnishes  excellent  sanitary  surroundings  for  working 
men  and  women  ten  hours  a  day,  why  should  I  not  furnish  tene- 
ments with  equally  healthful  conditions  and  surroundings  for  these 
people  during  the  remainder  of  the  twenty-four  hours?  In  fact,  in 
Massachusetts,  with  its  rigid  enforcement  of  factory  laws  calling  for 
proper  light,  cleanliness,  removal  of  dust,  pure  drinking  water,  re- 
ceptacles for  expectoration,  and  numerous  other  health  measures, 
the  question  is  often  asked :  "Why  have  we  not  a  tenement-house  law 
that  will  place  the  conditions  of  the  home  on  a  par  with  those  of 
the  factory  and  shop?" 

Such  industrial  hygiene  exhibits  might  be  brought  together  at 
some  central  place,  thereby  forming  a  museum  which  could  be 
visited  by  those  anxious  to  learn  just  what  is  being  done  for  the 
man  and  for  the  woman  who  works. 

IV.     PUBLICITY  THROUGH  LECTURES,  LEAFLETS,  AND  POSTED 

WARNINGS 

In  1908,  in  the  eleventh  health  district  in  my  state,  I  began  a 
series  of  noon-day  talks  in  the  different  large  manufacturing  estab- 
lishments, particularly  those  located  in  the  city  of  Worcester.  If  I 
may  speak  without  egotism,  I  believe  that  these  talks  were  of  im- 
mense educational  value.  They  were  given  in  lay  language  on  ques- 
tions of  personal  hygiene  and  sanitation,  including  the  use  of  pure 
air  and  the  importance  of  proper  exercise,  diet,  and  rest.  These 
lectures  were  largely  attended.  I  have  in  mind  at  this  moment  one 
establishment  employing  at  that  time  twelve  hundred  women  where, 
when  a  notice  was  posted  a  few  days  in  advance  that  this  talk  was  to 
be  given,  nine  hundred  remained  at  the  factory  during  the  noon  hour 
to  listen  to  what  they  must  have  considered  a  question  pertinent  to 


Education  for  the  Prevention  of  Industrial  Diseases        333 

their  welfare  and  well-being.  In  a  number  of  instances  manufac- 
turers shut  down  at  half  past  eleven  o'clock  to  allow  their  employees 
to  attend  my  lecture  without  its  interfering  with  their  noon  hour. 
During  these  lectures  I  usually  distributed  a  little  circular  on 
"Don't",  setting  forth  briefly,  and  recommending  the  avoidance  of 
certain  habits  detrimental  to  health.  These  little  leaflets  were  eager- 
ly sought  for;  I  believe  they  were  carried  home;  and  perhaps  the 
suggestions  were  followed.  At  any  rate,  I  had  the  satisfaction  of 
knowing  that  I  had  set  the  people  to  thinking.  Since  that  time  I 
have  been  pleased  to  learn  that  these  lectures  have  been  delivered  in 
several  other  states. 

It  is  my  opinion  that  the  posting  of  warnings,  whenever  this  can 
be  brought  about  in  large  industrial  establishments,  will  be  prolific  of 
much  good,  as  they  readily  attract  the  attention  of  all  the  employees 
and  at  least  set  them  to  thinking  as  to  their  meaning.  I  also  feel 
that  an  excellent  means  of  educating  the  industrial  worker  is  by  the 
distribution  of  leaflets  through  the  different  trade-union  organiza- 
tions. A  great  deal  of  good  can  be  brought  about  in  this  way,  and 
especially  effective  work  may  be  done  by  calling  the  attention  of  the 
employee  to  the  ordinary  care  needed  in  the  handling  of  articles  or 
chemicals  which  might  in  numerous  instances  be  conducive  to  the 
production  of  poisoning.  For  example,  attention  may  be  called 
to  the  need  of  ordinary  care  in  preventing  lead  poisoning.  These 
leaflets,  gotten  up  in  a  plain,  readable  manner,  and  printed  in  the 
several  languages  used  by  the  employees  in  the  different  industries, 
might  be  made  of  great  educational  value. 

V.    VENTILATION  AND  EYESTRAIN  LAWS 

In  Massachusetts  the  law  covering  the  ventilation  of  factories  and 
the  installation  of  mechanical  ventilating  apparatus  (Chapter  106, 
Sees.  51  and  52)  has,  I  believe,  brought  into  play  factors  which 
tend  in  many  instances  to  the  maintenance  of  bodily  resistance,  as 
well  as  to  the  prevention  of  many  industrial  diseases.  This  law 
provides  that  "a  factory  in  which  five  or  more  persons  and  a  work- 
shop in  which  five  or  more  women  or  young  persons  are  employed 
shall,  while  work  is  carried  on  therein,  be  so  ventilated  that  the  air 
shall  not  become  so  impure  as  to  be  injurious  to  the  health  of  the 
persons  employed  therein  and  so  that  all  gases,  vapors,  dust  or  other 
impurities,  injurious  to  health,  which  are  generated  in  the  course  of 
the  manufacturing  process  or  handicraft  carried  on  therein  shall,  so 


334  American  Labor  Legislation  Review 

far  as  practicable,  be  rendered  harmless."  Should  elements  detrimen- 
tal to  the  health  of  the  employees  be  found  in  any  of  these  factories 
or  workshops,  the  state  inspector  of  health  may  require  the  installa- 
tion of  mechanical  ventilating  apparatus.  In  any  instance  where 
much  dust  is  generated,  if  it  appears  to  the  state  inspector  of  health 
that  the  inhalation  of  such  dust  would  be  substantially  diminished 
without  unreasonable  expense  by  the  use  of  a  fan  or  other  mechani- 
cal means,  such  fan,  if  he  so  directs,  must  be  provided,  maintained, 
and  used.  In  all  of  the  dusty  trades,  as  well  as  in  rooms  which  are 
close  and  poorly  ventilated,  the  installation  of  fans  and  blowers  has 
had  its  effect  upon  the  health  of  the  employees.  The  enforcement  of 
this  statute  does  away  with  vitiated  and  foul  air,  to  which  otherwise 
the  employees  must  be  subject. 

Numerous  examples  of  the  practical  working  of  the  law  might  be 
given  if  space  permitted,  but  in  passing  I  will  mention  two.  In  the 
basement  of  a  large  manufacturing  establishment,  where  about  forty 
men  were  employed,  the  air,  which  appeared  damp,  was  heavy  and 
charged  with  carbon  dioxid,  and  the  men  were  continually  suffer- 
ing from  colds.  The  installation  of  two  small  fans  and  the  covering 
of  several  emery  wheels,  which  were  provided  with  suction  pipes, 
clarified  the  atmosphere  to  such  an  extent  that  the  men  told  me  they 
felt  as  if  they  were  working  in  the  open  air  as  compared  with  the 
conditions  under  which  they  had  worked  before  this  apparatus  was 
installed.  They  said  that  they  had  fewer  colds,  that  they  felt  more 
like  working,  and  that  they  could  do  better  work  without  getting 
tired.  In  other  words  their  physical  condition  underwent  a  change 
almost  immediately  after  the  installment  of  the  apparatus  mentioned 
and  the  removal  of  the  foul  and  heavy  air. 

In  another  instance,  in  the  weave  room  of  a  large  cotton  mill 
where  about  forty  girls  were  employed,  the  air  was  close  and  heavy, 
the  girls  went  about  their  work  in  a  listless  manner,  and  hardly  a 
day  elapsed  during  certain  seasons  of  the  year  but  several  of  them 
were  out  on  account  of  not  feeling  well.  After  the  installation  of  a 
large  fan,  which  removed  the  dust  as  well  as  the  overheated  atmos- 
phere and  allowed  fresh  air  to  take  its  place,  a  change  was  immedi- 
ately brought  about  which  was  at  once  noticeable  to  the  eye  of  the 
inspector.  There  was  less  absence  from  work,  denoting,  of  course, 
less  sickness  among  the  employees,  and  the  manner  in  which  they 
applied  themselves  to  their  work  showed  that  a  higher  degree  of 


Education  for  the  Prevention  of  Industrial  Diseases        335 

efficiency  was  being  maintained,  and  that  their  general  health  was 
much  better. 

Massachusetts,  I  believe,  is  the  only  state  in  the  union  which  has 
passed  any  act  relative  to  injuries  to  the  eyes  of  those  employed  in 
industrial  establishments.  This,  I  believe,  is  an  excellent  law  and 
will  do  away  with  many  cases  of  eyestrain,  of  headache,  and  of 
nervousness,  which  arise  from  improper  lighting  of  the  rooms  in 
which  people  are  employed.  In  going  into  this  question,  we  look 
first  to  the  natural  light  and  attempt  to  bring  about,  by  a  careful 
study  of  the  different  establishments,  the  best  condition  obtainable 
from  natural  light.  The  question  of  artificial  lighting,  the  kind  of 
light  and  its  effect  upon  the  eyes,  is  next  gone  over,  and  the  best 
light  which  our  experience  and  judgment  dictates  is  ordered  in- 
stalled. In  many  instances  simple  washing  of  windows  and  orders  as 
to  their  care  have  wrought  a  wonderful  change.  In  others,  the 
placing  of  more  windows  in  such  a  position  as  to  give  the  best  pos- 
sible light  has  proved  beneficial.  Then  again,  the  whitewashing  or 
painting  white  of  the  walls  and  ceilings  of  many  rooms  has  made  a 
change  in  the  condition  of  the  eyes  of  the  employees.  On  entering 
one  of  these  establishments,  we  first  determine  the  kind  of  work, 
whether  it  needs  close  application  of  the  eyes  or  not,  whether  many 
of  the  employees  are  wearing  glasses  and,  if  so,  why  they  are  worn, 
and  then  we  determine  the  effect  of  the  artificial  light  or  the  rays 
of  light  admitted  to  the  room  upon  the  eyes  of  the  employees.  Ques- 
tions are  asked  as  to  the  length  of  time  employed  in  the  present 
occupation,  the  condition  of  the  eyes  previous  to  this  employment, 
and  the  difficulties,  if  any,  under  which  the  employees  are  working. 

As  this  law  is  new,  and  as  many  changes  in  the  lighting  of  estab- 
lishments are  being  made  throughout  the  state,  we  are  as  yet  unable 
to  judge  of  the  beneficial  results  which  we  hope  to  obtain.  From 
my  personal  observation,  however,  I  believe  this  to  be  an  important 
step  which  the  state  has  taken,  and  I  believe  that  eyestrain  and 
kindred  industrial  diseases,  which  heretofore  were  caused  by  inade- 
quate and  improperly  lighted  rooms,  will  be  done  away  with  to  a 
large  extent.  There  is  no  doubt  in  my  mind  that  many  internal  dis- 
turbances, particularly  what  is  known  as  dyspepsia  or  nervous  indi- 
gestion, which  is  in  many  instances  the  result  of  eyestrain  and 
which  has  become  distinctly  an  industrial  disease,  will  be  done  away 
with.  If  this  be  true,  it  is  plain  that  the  general  condition  of  the 


336  American  Labor  Legislation  Review 

worker  must  be  bettered.  Physicians,  of  course,  have  for  a  long 
while  realized  that  much  malnutrition  and  consequent  general  weak- 
ness has  been  brought  about  by  eyestrain.  And  no  one  whose  occu- 
pation requires  close  application  to  fine  work  can  escape  its  deleterious 
effects  and  its  consequent  influence  over  the  general  nervous  system. 
This,  of  course,  leads  up  to  the  whole  question  of  industrial  disease 
as  related  to  the  eye.  In  comparing  notes  with  the  several  inspectors 
of  health  throughout  the  state,  we  can  arrive  at  but  one  conclusion 
and  that  is,  that  the  judicious  application  of  this  statute  will  be  rich 
in  beneficial  results  to  the  industrial  worker. 

VI.  EMPLOYERS'  TUBERCULOSIS  AGREEMENT 
It  is  said  that  all  medical  men  have  hobbies.  I  believe  once  in  a 
while,  however,  the  laity  credit  us  with  entertaining  practical  ideas. 
Appointed  state  inspector  of  health  in  1907,  with  instructions  to 
inspect  and  examine  minors  in  various  industries  throughout  my 
district,  I  knew  I  should  find  tuberculosis.  I  reasoned  that  in  the 
vast  majority  of  cases,  when  I  found  this  disease  in  a  boy  or  girl,  I 
should  also  find  that  they  did  not  have  the  four  dollars  a  week  re- 
quired of  all  who  would  enter  a  sanitarium,  even  if  such  opportunity 
was  open  to  them.  I  have  since  found  it  to  be  a  fact  that  more  than 
ninety  per  cent  of  the  workers,  when  stricken  with  this  disease,  have 
not  saved  for  the  so-called  rainy  day.  After  one  of  my  noon-day 
talks  a  young  girl  approached  me  saying  that  she  had  listened  to 
the  hope  which  I  held  out  to  those  having  tuberculosis  that  they 
might  be  cured  if  sent  early  to  a  sanitarium.  She  told  me  that  she 
had  tuberculosis  but  that  she  had  an  invalid  mother  whom  she  must 
support,  and  that  she  had  no  money.  I  took  up  this  case  with  the 
president  of  the  company  for  whom  she  worked,  and  he  not  only 
assured  me  that  he  would  pay  for  this  girl,  but  that  he  would  pay  for 
any  other  of  his  employees  who  might  be  so  stricken.  I  asked  him 
if  he  would  give  me  a  letter  to  this  effect.  He  did,  and  I  then  saw 
a  vast  field  opened  before  me.  I  went  to  other  manufacturers,  ask- 
ing for  the  same  pledge,  and  in  a  short  time  I  obtained  more  than  a 
hundred  similar  pledges. 

This  was  the  starting  of  what  the  Survey,  in  April,  1910,  saw  fit  to 
call  the  "Overlock  Tuberculosis  Agreement".  This  movement 
quickly  spread  throughout  the  city  of  Worcester  and  the  surrounding 
towns.  It  attracted  the  attention  of  the  Boston  Chamber  of  Com- 
merce, which  body,  by  accepting  a  year  later  a  recommendation  of 


Education  for  the  Prevention  of  Industrial  Diseases        337 

their  committee  on  the  prevention  of  disease,  adopted  it  without  a 
dissenting  voice.  Boards  of  trade  and  merchants'  associations 
throughout  New  England  took  up  the  matter  as  bodies.  The  move- 
ment has  spread  from  city  to  city  and  from  state  to  state,  until  I 
find,  by  conferring  with  my  co workers  in  different  states,  that  this 
agreement  at  the  present  time  protects  more  than  a  million  people. 

In  a  year's  time,  moreover,  the  work  which  I  had  done  began  to 
bear  fruit  in  a  different  direction,  which  I  had  not  anticipated  in  the 
beginning.  Young  men  and  women  were  sent  to  sanitariums,  into  the 
country,  and  to  their  homes  across  the  sea,  and  were  then  sent  back 
as  arrested  cases  to  become  teachers  in  sanitation  and  health  mat- 
ters. At  the  present  moment  I  think  I  can  say  that  there  are  in 
different  parts  of  New  England  and  the  eastern  states  more  than  five 
hundred  cases  under  treatment,  the  expenses  of  which  are  paid  by 
their  employers.  My  hope  now  is  that  this  movement  may  spread 
throughout  the  United  States. 

This  movement,  outside  of  its  humanitarian  and  economic  fea- 
tures, has  set  the  manufacturers  to  thinking.  They  began  at  once  to 
reason,  first,  as  to  why  they  should  have  tuberculosis  among  their 
employees ;  second,  as  to  whether,  if  it  did  occur,  it  was  because  of 
the  surroundings  under  which  they  were  working;  and  third,  what 
were  the  steps  necessary  to  place  their  different  establishments  under 
a  sanitary  regime  and  to  remove  as  fast  as  possible  all  causes  which 
lead  up  to  the  lowering  of  vitality  and  resistance  in  their  employees. 
They  soon  learned,  also,  that  by  placing  their  establishments  in  the 
best  possible  hygienic  condition  the  efficiency  of  their  employees  was 
increased.  I  have  been  much  gratified  in  the  past  three  years  by  the 
whole-souled  cooperation  of  the  manufacturers  in  this  movement. 
They  at  once  began  to  extend  the  welfare  work,  in  their  several 
establishments,  so  that  at  the  present  time  not  only  do  many  of  the 
large  establishments  provide  recreation  halls,  but  they  are  serving 
the  noon-day  meal  at  its  bare  cost.  This  sentiment  existing  among 
the  business  men  of  a  community  must  necessarily  have  its  effect 
upon  the  whole  community.  The  local  health  authorities,  who  in 
too  many  instances  in  the  past  have  been  sadly  remiss  and  dilatory 
in  the  manner  in  which  they  enforced  laws,  have  had  it  pointed  out 
to  them  that  they  must  cooperate  in  matters  pertinent  to  the  health 
of  the  community. 

The  steps  taken  for  the  eradication  of  tuberculosis  from  industry 


338  American  Labor  Legislation  Review 

are  the  very  steps  which  must  be  taken  for  the  prevention  of  indus- 
trial diseases  in  general.  This  movement,,  in  the  localities  in  which 
it  has  been  applied,  unites,  we  find,  all  sects,  all  creeds,  all  schools  of 
medicine,  in  one  common  brotherhood.  Your  organization,  acting  in 
conjunction  with  the  organized  forces  which  I  have  mentioned,  may 
be  a  most  potent  factor  in  bringing  about  the  cooperation  of  the 
various  agencies  needed  in  the  campaign  of  education  for  the  pre- 
vention of  industrial  diseases. 


NOTIFICATION   OF  OCCUPATIONAL  DISEASES 


CRESSY  L.  WILBUR 
United  States  Bureau  of  the  Census. 


The  notification  of  occupational  diseases  has  a  somewhat  similar 
relation  to  the  registration  of  deaths  from  occupational  diseases 
that  the  notification  of  births  has  to  the  registration  of  births. 
Notification  in  each  case — and  to  be  entitled  to  be  considered  real 
notification  it  must  be  immediate — is  for  the  purpose  of  giving  the 
earliest  possible  information  to  the  authorities  charged  with  the 
supervision  or  control  of  the  class  of  events.  Immediate  notifica- 
tion of  births  is  chiefly  for  the  purpose  of  enabling  the  sanitary  au- 
thorities to  insist  upon  the  necessary  precautions  for  the  preven- 
tion of  ophthalmia  neonatorum  and  of  infant  sickness  and  mortal- 
ity. It  is  not  intended  to  replace  the  registration  of  births,  for 
which  a  reasonable  interval  must  be  allowed,  at  least  in  rural  dis- 
tricts; but  it  may  serve  as  an  important  aid  in  securing  complete 
registration,  while  the  birth  registration  law  may  in  return  help  to 
secure  the  thorough  enforcement  of  notification.  The  purposes  of 
such  laws  may  be  combined,  as  in  the  recent  Massachusetts  statute, 
which  provides  that  physicians  and  midwives  shall,  within  forty- 
eight  hours  after  the  birth  of  a  child,  mail  a  notice  thereof  to 
the  local  registrar  (notification),  and  within  fifteen  days  file  a  cer- 
tificate of  birth  (registration),  but  that  the  notification  shall  not 
be  required  if  the  birth  is  registered  within  forty-eight  hours. 

In  like  manner  the  notification  of  sickness  from  occupational  dis- 
ease will  be  followed,  in  a  certain  proportion  of  cases,  by  the  regis- 
tration of  death.  The  notification  of  all  cases  of  occupational  or 
industrial  diseases  ought  to  be  a  most  valuable  aid  for  the  com- 
plete and  satisfactory  registration  of  all  deaths  from  such  diseases ; 
and  likewise  the  registration  of  the  deaths  should  be  a  most  im- 
portant check  on  the  completeness  and  promptness  of  the  notifica- 
tion. It  is,  therefore,  desirable  that  the  notification  and  registra- 
tion of  occupational  sickness  and  mortality  should  be  thoroughly 


340  American  Labor  Legislation  Review 

correlated,  and  for  this  reason  it  will  probably  be  found  necessary 
to  administer  them  under  the  same  general  direction. 

The  notification  of  occupational  diseases  may  properly  be  con- 
sidered a  part  of  the  general  subject  of  the  notification  or  regis- 
tration of  sickness  in  general.  The  reporting  of  sickness  is  a  very 
difficult  matter  to  deal  with,  and  morbidity  statistics  are,  as  a  rule, 
far  less  complete  than  statistics  of  mortality.  Even  with  respect 
to  some  of  the  most  important  infectious  diseases,  such  as  typhoid 
fever,  diphtheria,  and  tuberculosis,  it  will  be  found  that  in  some 
localities  many  cases  fail  to  be  reported.  This  is  readily  shown 
by  comparison  of  the  reported  cases  of  sickness  with  the  deaths 
registered,  according  to  which  a  most  absurd  ratio  of  fatality  will 
not  infrequently  be  shown.  Such  indications  prove  that  physicians 
fail  to  a  considerable  extent  to  report  the  occurrence  of  notifiable 
diseases ;  and  knowledge  of  this  fact  by  the  sanitary  authorities 
should  lead  to  rigorous  enforcement  of  the  law,  with  prosecution 
and  the  collection  of  fines  when  it  is  disregarded.  It  is  likely  that 
the  same  condition  will  be  found  to  exist  in  the  administration  of 
laws  requiring  the  notification  of  occupational  diseases;  and  the 
whole  experience  of  general  registration  points  to  the  necessity  of 
rigid  and  thorough  enforcement  of  law  from  the  very  beginning, 
if  fully  dependable  results  are  to  be  obtained  and  the  true  value  of 
such  legislation  is  to  be  demonstrated.  It  is  far  easier  to  enforce 
a  reasonable  law  from  the  start  than  to  restore  the  efficiency  of 
a  law  that  has  become  more  or  less  of  a  dead  letter. 

The  registration  of  sickness  does  not  come  in  the  scope  of  the 
Bureau  of  the  Census,  which  receives  and  compiles  the  returns  of 
deaths  from  the  registration  area  of  the  United  States.  I  shall, 
therefore,  deal  chiefly  with  the  relation  of  the  notification  of  oc- 
cupational diseases  to  the  registration  of  deaths  from  occupational 
diseases.  It  may  be  proper  to  point  out,  however,  that  the  re- 
ported mortality  from  occupational  diseases  is  as  yet  relatively 
insignificant,  and  the  true  measure  of  the  loss  of  health  and  ef- 
fective working  power  can  only  be  learned  from  well-kept  mor- 
bidity returns.  For  example,  during  the  year  1910  there  were, 
in  the  registration  area  of  the  United  States,  comprising  an  esti- 
mated population  of  53,843,896,  or  58.3  per  cent  of  the  total 
population  of  continental  United  States,  and  including  practically 
all  of  the  chief  industrial  states  of  the  north  and  west,  only  one 


Notification  of  Occupational  Diseases  341 

hundred  and  thirty-six  deaths  reported  from  chronic  lead  poison- 
ing and  six  deaths  from  other  chronic  occupational  poisonings  out 
of  a  total  of  805,412  deaths  from  all  causes.  All  the  deaths  from 
chronic  lead  poisoning  were  not  occupational  in  character.  The 
very  small  number  of  deaths  (six)  from  other  chronic  occupa- 
tional poisonings  includes  all  deaths  reported  from  phosphorus 
necrosis  (whether  specified  as  industrial  or  not),  from  chronic 
industrial  arsenical  and  mercurial  poisonings,  etc.  It  is  likely, 
however,  that  some  deaths  that  should  have  been  classified  under 
this  title  were  omitted  because  the  certificates  of  death  bore  no 
evidence  as  to  the  industrial  character  of  the  poisonings,  and  some 
may  have  been  reported  under  terms  relating  to  mere  symptoms  or 
conditions,  such  as  "paralysis,"  "necrosis,"  etc.,  that  afforded  no 
clue  to  the  true  nature  of  the  cause  of  death.  The  returns  were 
compiled  in  strict  accordance  with  the  international  classification; 
and  it  is  impracticable  for  the  Bureau  of  the  Census  to  investigate 
all  doubtful  statements  of  cause  of  death,  although  this  is  done  to 
a  certain  limited  extent.  The  responsibility  for  indefinite  reports 
rests,  primarily,  upon  the  recording  physician,  and,  secondarily,  upon 
the  local  registrar  of  vital  statistics  who  accepts  a  doubtful  certi- 
ficate and  issues  a  burial  permit  thereon. 

It  may  be  noted  in  the  above  statement  in  regard  to  "occupational 
diseases"  that  the  term  is  used  in  the  very  limited  sense  of  occupa- 
tional poisonings,  and  not  in  the  broader  sense  of  all  diseases  af- 
fected by  occupations.  Thus  the  draft  of  the  "Certificate  of  Indus- 
trial Diseases"  issued  by  the  New  York  State  Department  of  Labor 
provides  for  the  reporting  of  "poison  by  lead,  phosphorus,  arsenic, 
or  mercury  or  their  compounds,  or  from  anthrax,  or  from  com- 
pressed-air illness."  The  schedules  of  California,  Wisconsin,  Con- 
necticut, New  Jersey,  Maryland,  and  Michigan  are  the  same  as 
that  of  New  York,  while  Illinois  requires  the  reporting  of  "disease 
or  illness  due  or  incident  to"  a  few  specified  dangerous  occupa- 
tions. The  very  recent  introduction  of  such  legislation  is  indicated 
by  the  fact  that  these  eight  states  are  the  only  ones  having  such 
laws.  The  report  of  the  Illinois  Commission  on  Occupational  Dis- 
eases (January,  191 1)  related  chiefly  to  industrial  poisonings,  al- 
though the  scope  of  a  more  comprehensive  investigation  was  fully 
pointed  out.  It  may  be  asked,  for  example,  whether  the  reporting 
of  tuberculosis  caused  by,  or  aggravated  by,  occupation  is  contem- 


342  American  Labor  Legislation  Review 

'plated  as  a  regular  procedure  by  means  of  any  of  the  special  noti- 
fication blanks? 

It  is  difficult  to  define  those  diseases  that  may  or  may  not  be 
affected,  to  some  extent,  by  conditions  incident  to  employment. 
The  general  study  of  occupational  mortality  is  dependent  upon 
comparison  of  the  deaths  from  various  causes  of  persons  engaged 
in  specified  occupations  with  the  corresponding  populations  or  lives 
at  risk,  a'nd  it  is  hardly  necessary  to  say  that  regard  must  be  had 
to  the  age  and  sex  distribution,  as  well  as  to  the  factors  of  race  and 
color,  in  order  to  obtain  comparable  results.  It  is  absolutely  neces- 
sary that  there  should  be  a  uniform  classification  of  causes  of  death, 
that  physicians  should  report  the  causes  of  death  by  means  of  pre- 
cise and  definite  terms  that  can  be  readily  compiled  thereunder,  and 
also  that  there  should  be  an  identical  classification  of  occupations  in 
use  for  both  the  population  and  mortality  returns.  In  order  to  make 
the  latter  of  the  greatest  service,  physicians  and  others  must  be  in- 
structed in  regard  to  the  correct  statement  of  occupations. 

It  is,  therefore,  very  gratifying  that  a  standard  form  of  certifi- 
cate of  death  has  come  into  general  use  in  the  United  States  dur- 
ing the  last  ten  years,  prior  to  which  time  there  was  very  little  uni- 
formity in  this  respect.  This  blank  was  originally  prepared  in  1902 
and  was  revised  in  1909  by  the  organized  registration  officials  of  the 
country  (Section  on  Vital  Statistics  of  the  American  Public  Health 
Association).  I  desire  to  call  attention  especially  to  the  form  of 
statement  of  occupation  on  the  present  blank,  with  specification  of 
the  "(a)  Trade,  profession,  or  particular  kind  of  work",  and  "(b) 
General  nature  of  industry,  business  or  establishment  in  which  em- 
ployed", and  to  the  instructions  on  the  back  of  the  certificate  rela- 
tive to  the  statement  of  occupation  and  cause  of  death.  Although 
not  as  detailed  as  the  information  sought  on  the  New  York  certifi- 
cate of  industrial  diseases,  it  was  the  general  consensus  of  opinion 
among  registration  officials  that  the  statement  was  as  complete  as 
it  would  be  practicable  to  require  in  the  general  mortality  returns. 
The  necessity  for  full  information  in  regard  to  the  length  of  time 
employed,  the  previous  employment,  previous  illnesses  due  to  occu- 
pation, etc.,  can  best  be  met  by  including  such  inquiries  on  the  no- 
tification blank,  thus  avoiding  incumbering  the  death  certifi- 
cate with  many  questions  in  addition  to  those  already  required  for 
the  general  purposes  of  vital  statistics.  Thus  the  two  blanks  to  a 


Notification  of  Occupational  Diseases  343 

large  extent  supplement  each  other,  and  may  be  used  together  as  a 
basis  for  many  important  statistical  purposes  and  intensive  investi- 
gations. It  would  seriously  interfere  with  the  conduct  of  death 
registration,  the  extension  of  which  to  cover  the  entire  United 
States  is  one  of  the  most  important  tasks  in  which  the  Bureau  of 
the  Census  is  cooperating  with  state  authorities  and  national  asso- 
ciations, to  add  a  single  additional  question  to  the  schedules,  which 
are  already  regarded  as  cumbrous  by  legislatures  and  those  not  fa- 
miliar with  the  requirements  of  registration  laws.  But  a  state  of 
high  industrial  development  can  readily  obtain,  by  means  of  such 
blanks  as  are  provided  for  notification  of  industrial  diseases,  all 
supplemental  data  required  to  make  its  occupational  statistics  of 
the  greatest  practical  value. 

A  very  beneficial  means  of  building  up  complete  and  correct 
statistics  of  occupational  mortality  for  the  United  States  lies  in  the 
education  of  physicians,  undertakers,  and  others  in  regard  to  the 
proper  statement  of  occupation  upon  certificates  of  death,  and  in 
training  physicians  to  report  the  causes  of  death  under  precise 
designations.  For  the  latter  purpose  a  booklet  entitled  the  Phy- 
sicians' Pocket  Reference  to  the  International  List  of  Causes  of 
Death  has  been  distributed  by  the  Bureau  of  the  Census  to  all  the 
physicians  of  the  United  States.  It  contains  lists  of  indefinite  and 
unsatisfactory  terms,  and  also  points  out  the  importance  of  examin- 
ing the  statement  of  occupation  (not  usually  filled  in  by  the  phy- 
sician) so  that  full  data  may  be  available  concerning  the  occupa- 
tional influences  affecting  causes  of  death.  Similar  instructions  are 
used  by  state  and  local  authorities;  and  it  is  only  necessary,  with 
the  growing  knowledge  of  the  importance  of  the  statement  of  occu- 
pational diseases,  to  make  such  instructions  just  as  precise  as  may 
be  necessary.  I  believe  that  it  might  be  useful  for  a  committee  of 
this  Association  to  consider  the  subject  and  to  cooperate  with  the 
registration  officials  and  with  the  Bureau  of  the  Census  in  obtain- 
ing more  complete  returns.  Objections  not  infrequently  arise  when 
a  local  or  state  registrar  questions  the  completeness  of  a  return  of 
death,  that  would  be  removed  if  a  great  national  organization  had 
pronounced  clearly  in  regard  to  the  necessity  for  full  details. 

In  this  connection  I  may  say  that  the  reporting  of  the  causes  of 
occupational  mortality  has  suffered,  in  common  with  all  reports  of 
causes  of  death,  from  the  entire  absence  in  this  country  of  an  ac- 


344  American  Labor  Legislation  Review 

cepted  nomenclature  of  diseases.  I  do  not  mean  by  this  that  we 
do  not  have  a  standard  classification,  or  preferably  statistical  list, 
of  causes  of  death  and  illness.  The  latter  necessity  was  met  by 
the  general  adoption  of  the  International  List  in  1900,  since  revised 
at  Paris  in  1909.  But  this  list  is  solely  for  statistical  purposes  and 
does  not  answer  the  purpose  of  a  nomenclature,  or  authoritative 
guide  for  the  selection  of  medical  terms  for  the  designation  of  dis- 
eases and  conditions,  such,  for  example,  as  the  "Nomenclature  of 
Diseases  of  the  Royal  College  of  Physicians  of  London",  which  has 
been  the  accepted  authority  in  England  for  the  past  forty  years. 
I  am  glad  to  say  that  the  American  Medical  Association  has  un- 
dertaken to  supply  this  deficiency,  and  that  its  Committee  on  the 
Nomenclature  and  Classification  of  Diseases  has  held  several  ses- 
sions during  the  present  meeting  of  that  association  and  will  sub- 
mit a  report  calling  for  the  publication  of  a  nomenclature  for  im- 
mediate practical  use.  In  this  nomenclature,  which  must  neces- 
sarily be  regarded  as  somewhat  provisional  or  tentative  in  charac- 
ter— although  the  committee  has  labored  upon  the  subject  for  sev- 
eral years — precise  directions  will  be  given  for  the  reporting  of 
industrial  poisonings,  and  the  importance  of  such  reports  will  be 
emphasized  as  earnestly  as  possible.  It  is  hoped  that  any  sugges- 
tions on  the  subject  from  members  of  this  Association,  and  also 
any  action  which  may  be  taken  by  the  Association  on  the  basis  of 
the  papers  presented  by  Dr.  Thompson  and  others,  may  be 
promptly  sent  in  to  the  committee,  a  statement  and  report  by  which 
may  be  found  in  recent  issues  of  the  Journal  of  the  American 
Medical  Association. 

The  nomenclature  will  be  arranged  in  the  order  of  the  Interna- 
tional List,  in  accordance  with  the  original  resolution  of  the  House 
of  Delegates  adopted  in  1907.  This  is  for  the  purpose  of  compara- 
bility with  the  statistical  lists  employed  for  the  compilation  of  mor- 
bidity and  mortality  statistics.  For  the  essential  use  of  the  nomencla- 
ture the  question  of  classification  is  of  minor  importance.  One  ar- 
rangement may  be  as  good  as  another  for  the  presentation  of  indus- 
trial diseases,  but  as  a  matter  of  convenience  it  is  desirable  that  tables 
should  present  causes  of  death  as  far  as  possible  in  the  interna- 
tional order.  Of  course,  the  titles  of  the  International  List  can  be 
subdivided  to  any  extent  found  necessary,  but  when  this  is  done 
the  aggregates  should  be  comparable  with  the  causes  shown  under 


Notification  of  Occupational  Diseases  345 

the  corresponding  titles  in  general  morbidity  and  mortality  statis- 
tics. The  Bureau  of  the  Census  and  the  Registrar-General  of  Eng- 
land have  recently  published  manuals  for  the  assignment  of  terms 
to  the  International  List,  so  that  a  convenient  guide  will  be  available 
for  all  offices  compiling  statistics  of  occupational  causes  of  death. 
Thus  the  general  comparability  of  all  classes  of  mortality  and 
morbidity  statistics  will  be  assured. 


MEDICAL  INSPECTION  OF  FACTORIES  IN  ILLINOIS 


HAROLD  K.  GIBSON 
Medical  Inspector  of  Factories  in  Illinois. 


Is  the  Occupational  Disease  Act  of  Illinois  in  its  application 
practical  ?  To  this  question,  although  appreciating  the  fact  that  our 
experience  is  all  too  brief,  I  must  answer  most  emphatically  in  the 
affirmative.  There  have  been  reported,  in  the  period  from  August 
i,  1911,  to  April  i,  1912,  two  hundred  and  forty-seven  cases  of  occu- 
pational or  industrial  disease,  which  were  divided  as  follows : 

Lead 240 

Arsenic   6 

Phosphorus  necrosis i 


Total   247 

When  it  is  taken  into  consideration  that  in  this  period  not  to 
exceed  thirty-one  manufacturing  establishments  were  reporting, 
the  importance  of  this  legislation,  particularly  as  it  concerns  the 
reporting  of  occupational  disease,  may  be  grasped. 

Personal  experience  has  taught  me  that  the  Occupational  Disease 
Act,  as  applied  in  our  state,  must  fall  far  short  of  its  mission  unless 
we  keep  continually  before  us  the  idea  of  education,  not  only  of 
employee,  but  of  employer.  I  have  with  me  now,  indeed,  the  mental 
picture  of  two  large  manufacturers  of  paints  whom  we  will  desig- 
nate as  X  and  Z.  Both  plants  are  new  and  well  equipped  with 
modern  devices  for  collecting  dust;  both  have  shower-baths,  abun- 
dant facilities  for  washing,  dining  rooms,  compartment  lockers, 
working  clothes,  and  regular  medical  examinations  by  well-qualified 
physicians.  X  reported  eight  cases  of  industrial  lead  poisoning  for 
the  month  of  October.  Z  reported  seven.  From  this  period  until 
April  i,  the  monthly  reports  of  X  have  failed  to  show  a  single 
case  of  lead  poisoning;  while  Z,  on  the  contrary,  has  reported  on 
an  average  of  four  cases  monthly  since  October.  Why  this  great 
discrepancy  in  two  large  industrial  concerns  using  a  practically  identi- 


Medical  Inspection  of  Factories  in  Illinois  347 

cal  process,  having  the  same  number  of  employees,  both  of  modern 
building  construction  and  sanitation,  and  both  complying  with  our 
occupational  disease  law?  Because  X  is  complying  with  the  spirit 
as  well  as  the  letter  of  the  law,  while  Z  is  complying  only  with  the 
letter.  Being  present  in  X's  plant  recently  when  the  noon  whistle 
blew  for  lunch,  I  was  surprised  to  find  that  X  not  only  allowed 
sufficient  time  for  thorough  scrubbing  of  the  hands  and  face,  but 
that  the  firm  provided  a  man  whose  duty  it  was  to  see  that  all 
hands  were  clean  before  the  food  was  taken  from  the  locker. 

It  is  merely  a  difference  in  superintendents,  foremen,  and  shop 
discipline.  An  employee  in  the  plant  of  X  knows  that  the  creation 
of  an  unnecessary  amount  of  dust,  as,  for  example,  in  opening 
a  container  of  white  lead,  or  the  failure  to  wear  his  respirator 
where  there  is  dry  grinding,  means  a  reprimand  from  the  foreman 
or,  if  he  is  a  chronic  offender,  dismissal.  On  the  other  hand,  the 
superintendent  at  Z  plant  is  a  lead  man  of  thirty  years'  experience, 
who  boasts  he  has  never  been  leaded,  and  who  believes  that  chewing 
tobacco  is  the  greatest  of  all  prophylactic  measures  in  the  prevention 
of  lead  poisoning.  It  was  interesting  to  note,  however,  that  this 
man,  although  not  a  user  of  alcohol,  had  a  blood  pressure  of  one 
hundred  and  sixty  and  peripheral  blood-vessels  of  the  consistency  of 
whipcords.  Z  will  not  get  results  in  his  plant,  with  all  of  his 
modern  sanitary  apparatus,  fans,  and  dust  collectors,  until  he  gets 
foremen  who  will  personally  supervise  the  hygiene  of  his  men.  I 
grant  you  that  this  is  not  a  simple  matter. 

Quite  recently,  in  the  inspection  of  the  linotyping  room  of  one 
of  our  largest  dailies,  equipped  with  a  splendid  exhaust  system, 
the  men  complained  bitterly  that  the  exhaust  and  fans  caused  colds 
and  sore  throats.  These  are  purely  matters  of  education.  Then 
there  is  the  employer  who  tells  you  that  the  men  prefer  the  saloon 
to  the  dining  room  and  will  not  use  a  shower-bath,  and  that  the 
men  will  not  wear  respirators ;  he  is  as  badly  in  need  of  education  as 
his  employees.  Demonstrate  to  him  what  an  intelligent  foreman  can 
accomplish. 

Will  you  allow  me  to  tell  you  of  our  experience  with  the  Pullman 
Car  Company  which,  by  the  way,  was  the  first  corporation  to  comply 
with  the  occupational  disease  law  in  Illinois?  Their  first  report 
made  after  our  preliminary  inspection  showed  seventy-three  cases 
of  lead  poisoning.  Bear  in  mind  that  they  employ  between  three 


348  American  Labor  Legislation  Review 

hundred  and  six  hundred  painters  and  interior  finishers,  and  that 
these  people  are  engaged  in  an  occupation,  peculiar  to  the  finishing 
of  Pullman  cars,  which  is,  I  believe  from  personal  experience,  the 
most  fraught  with  danger  of  any  of  the  occupations  in  which  lead 
is  handled.  I  refer  to  the  dry  sander  of  lead  inside  the  Pullman 
car.  Here  a  group  of  men  is  confined  in  a  relatively  small  place 
devoid  of  artificial  ventilation,  rubbing  down  dry  lead  paint  with 
emery  paper.  They  told  us  in  the  beginning  that  men  could  not  be 
made  to  wear  respirators  in  such  a  case;  that  they  would  want  to 
temporize  with  a  strip  of  gauze  or  a  handkerchief  tied  over  nose  and 
mouth.  I  wish  to  emphasize  the  point  that  in  this,  the  most  dan- 
gerous of  the  lead  trades,  the  gauze  or  handkerchief  will  not  do. 
Only  an  approved  respirator,  constantly  worn  when  at  work,  and  the 
most  scrupulous  personal  hygiene,  will  save  the  dry  sander  of  lead. 
His  work  admits  of  no  compromise. 

To  recapitulate,  the  Pullman  company  had  seventy-three  cases  in 
August;  they  have  not  had  a  case  for  the  past  four  months.  They 
have  a  perfect  equipment  of  baths,  washing  facilities,  lockers,  clothes, 
and  dining  rooms ;  but  more  than  that  they  have  a  safety  department 
with  a  man  at  its  head  who  is  an  enthusiast  in  his  work  and  who 
believes  that  lead  poisoning  in  employees  can  be  practically  elimi- 
nated by  personal  supervision.  Remember,  too,  that  these  men,  of 
all  classes  of  lead  workers,  are  doing  the  character  of  work  which 
furnishes  the  greatest  number  of  cases  of  lead  poisoning.  That  is 
to  say,  they  are  painters  and  sanders. 

Permit  me,  also,  to  say  a  few  words  upon  the  importance  of  what 
our  German  colleagues  call  the  symptom  complex  in  making  a  diag- 
nosis of  industrial  disease.  I  will  refer  to  lead,  as  it  is  easily  the 
most  frequent  and  has  the  most  disastrous  final  results  of  any  of 
our  industrial  poisons.  The  blue  line  is  by  no  means  pathognomonic 
of  lead  poison,  nor  is  a  basophilic  degeneration  unless  a  previous 
malaria  can  be  excluded,  and  it  must  be  borne  in  mind  that  many  of 
our  lead  workers,  at  least  in  Illinois,  come  from  the  malarial  belt  of 
southern  Europe.  Muscular  weakness  in  any  group  of  muscles  with 
anemia  I  regard  as  most  suggestive,  even  without  colic  or  blue  line. 
You  must  not  ask  a  man  if  he  has  abdominal  pain,  but  if  he  has  pain 
and  where,  giving  importance  to  the  group  of  symptoms  rather  than 
to  any  one  symptom,  unless,  of  course,  it  be  a  wrist-drop  or  a  typi- 
cal colic.  I  have  found  what  I  considered  a  well-marked  case  of 


Medical  Inspection  of  Factories  in  Illinois  349 

lead  poisoning  where  there  was  no  history  of  pain,  muscular  weak- 
ness or  paralysis,  and  no  blue  line,  but  a  moderate  anemia,  albumin- 
uria,  and  a  blood  pressure  of  one  hundred  and  eighty,  with  a  baso- 
philic  degeneration.  Of  course,  in  estimating  the  value  of  blood  pres- 
sure, one  must  exclude  alcoholism  and  evidence  of  venerial  disease. 
Just  a  word  in  regard  to  the  importance  of  basophilic  degeneration  as 
a  sign  of  lead  poisoning.  In  a  series  of  twenty-six  cases,  all  of  which 
presented  a  certain  degree  of  anemia,  I  found  this  sign  present  in 
twenty-one  cases. 

If  I  have  dwelt  upon  lead  to  the  seeming  exclusion  of  other 
poisons,  it  is  because  of  its  commercial  importance.  I  am  sure 
that  we  in  Illinois  owe  a  debt  of  everlasting  gratitude  to  this  Asso- 
ciation and  to  your  honorable  secretary,  in  particular,  for  his  efforts 
in  the  matter  of  white  phosphorus  legislation.  The  Esch-Hughes 
Act  will  eliminate  one  plague  spot  from  our  industrial  disease  map  in 
Illinois,  and  one  which  was  particularly  offensive,  as  70  per  cent  of 
the  employees  exposed  to  the  fumes  of  phosphorus  were  girls  under 
the  age  of  twenty.  But  consider,  I  beg  of  you,  that  while  phosphorus 
necrosis  is  a  loathsome  disease,  yet  it  is  strictly  a  local  disease,  and 
where  it  numbers  its  victims  in  tens,  lead  numbers  its  victims  in 
thousands.  I  wonder  how  many  lead  workers  of  all  grades  could 
obtain  a  standard  life  insurance  policy  at  the  age  of  thirty-five.  Re- 
member, too,  that  the  atheromatous  changes  produced  in  the  vessel 
walls  by  lead,  as  also  the  kidney  changes,  are  permanent. 


COMPRESSED-AIR  ILLNESS  IN  CAISSON  WORK 


L.  M.  RYAN 
Medical  Examiner,  New  York  Foundation  Company. 


Under  conditions  as  they  exist  in  New  York  at  present  employ- 
ment in  compressed  air  is  not  such  a  dangerous  occupation  as  it 
was  a  few  years  ago.  As  improvements  have  been  made  in  equip- 
ment for  lessening  the  laborious  part  of  the  work  and  for  over- 
coming the  difficult  problems  of  engineering,  so  has  there  been  a 
great  advance  toward  bettering  the  conditions  under  which  the  men 
are  working.  Chief  among  the  altered  conditions  which  have  less- 
ened the  dangers  of  loss  of  life  from  caisson  disease  are:  (i)  phy- 
sical examination  of  all  employees;  (2)  shortening  the  hours  of 
labor;  (3)  hospital  locks,  in  charge  of  qualified  attendants,  where 
victims  of  the  "bends"  can  be  immediately  recompressed ;  (4) 
lengthening  the  time  of  decompression  in  coming  from  work;  (5) 
substitution  of  electricity  for  candlelight;  and  (6)  a  greater  ten- 
dency on  the  part  of  the  men  to  sobriety. 

I  am  speaking  now  with  reference  to  the  work  of  sinking  cais- 
sons for  foundations  of  buildings,  and  particularly  of  the  compressed- 
air  work  during  the  last  five  years  in  connection  with  many  of 
the  large  buildings  in  lower  Manhattan.  Caissons  or  large  vertical 
boxes  are  sunk  to  rock  or  hardpan,  as  necessity  may  demand.  As 
the  earth  is  excavated  from  underneath  and  inside  the  boxes  the 
caisson  settles,  so  that  when  rock  or  hardpan  is  reached  we  have 
a  hollow  vertical  cylinder,  or  a  miniature  tunnel,  leading  from  the 
surface  of  the  ground  to  a  solid  support.  For  a  building  which 
extends  over  a  large  area  a  great  many  of  these  caissons  have  to 
be  sunk.  In  the  case  of  the  municipal  building  of  New  York,  for 
example,  one  hundred  and  six  caissons  were  sunk  to  a  depth  of  one 
hundred  and  twelve  feet  below  water  level  and  one  hundred  and 
thirty-five  feet  below  the  street  level.  These  boxes  or  caissons  are 
sunk  in  groups  of  three,  four,  five,  or  six,  so  that  a  force  of  from 
one  hundred  to  one  hundred  and  fifty  men,  or  even  as  many  as 
five  hundred  men,  are  employed  at  one  time.  The  air  is  pumped 
from  air  compressors  to  the  caissons  and  the  pressure  varies  ac- 


Compressed- Air  Illness  in  Caisson  Work  351 

cording  to  the  depth  of  sinking,  so  that  at  the  same  moment  we 
may  have  one  caisson,  which  is  nearing  its  destination,  having  a 
pressure  of  as  much  as  forty-five  or  forty-six  pounds  and  another 
one,  just  being  begun,  having  a  pressure  of  only  two  or  three  pounds. 

In  caisson  work  we  have  a  few  difficulties  to  be  dealt  with  that 
are  not  met  in  tunnel  work,  but  in  the  main  the  problem  is  the 
same.  The  percentage  of  cases  of  compressed-air  disease  in  my 
experience  has  been  lower  on  foundation  work  than  in  tunnel  work, 
in  spite  of  the  fact  that  under  most  circumstances  employees  in 
caissons  are  working  under  more  disadvantageous  conditions  than 
tunnel  workers.  The  reason  for  this  is,  I  think,  that  in  tunnel 
work,  up  to  the  present  time,  for  the  same  pressure  the  men  have 
worked  longer  hours.  In  caisson  work  our  main  difficulty  in  the 
past  has  been  in  lengthening  the  time  of  decompression  on  exit  from 
work.  One  reason  for  this  is  that,  on  account  of  the  comparatively 
small  size  of  the  lock  used  in  this  work  and  through  which  all  em- 
ployees must  pass,  it  is  a  much  greater  mechanical  problem  to  di- 
minish the  pressure  gradually.  I  mean  that,  comparing  two  locks, 
one  large  and  the  other  small,  with  an  equal  pressure  of  air  on  them, 
if  you  release  the  same  amount  of  air  from  each  through  the 
same  sized  valve,  the  pressure  in  the  small  lock  will  drop  much 
more  quickly  than  in  the  large  one.  Another  reason  is  that  the 
lock  used  on  the  caisson,  in  contrast  with  tunnel  work,  is  not 
permanently  placed,  as  it  must  be  lowered  with  the  caisson.  The 
necessity  for  the  frequent  removal  of  locks  leaves  a  greater  mar- 
gin of  chances  for  leaks  to  occur  from  time  to  time,  and  from  a 
leaky  lock  it  is  almost  impossible  to  release  the  air  slowly.  In 
addition,  the  cramped  position  that  the  air  worker  must  assume 
while  sitting  in  the  bucket  during  decompression  differs  from  the 
comparative  comfort  with  which  he  issues  from  a  tunnel  lock. 
Another  feature  of  caisson  work  that  has  to  be  reckoned  with  is 
the  environment  of  a  busy  city,  as  compared  with  the  location  of 
a  tunnel  plant  which  is  usually  in  a  more  secluded  section.  In  the 
former  case  the  force  of  men,  like  the  pressure  of  the  air,  is  con- 
stantly changing;  in  the  latter  the  tendency  is  more  for  the  force 
to  be  a  steady  one,  for  the  men  have  a  pressure  to  work  in  that 
is  pretty  nearly  constant  and  is  not  accompanied  with  the  same 
degree  of  uncertainty. 

In  considering  the  problem  of  how  to  care   for  the  men,  the 


352  American  Labor  Legislation  Review 

two  factors  that  are  of  the  utmost  importance  are:  (i)  the  rejec- 
tion for  work  of  all  physically  unfit;  and  (2)  slow  decompression 
in  coming  from  work.  The  only  death  that  has  occurred  in  any  of 
the  work  of  which  I  have  had  charge  during  the  last  five  years 
was  due  to  a  pressure  of  only  twelve  pounds  of  air  where  a  man 
had  gone  to  work  without  having  been  examined.  Post-mortem 
examination  showed  that  he  had  had  a  dilated  heart  which  ruptured 
from  the  strain  of  a  fairly  rapid  decompression.  Very  few  cases 
of  caisson  disease  occur  in  a  pressure  less  than  twenty  pounds. 
In  the  examination  of  the  men  it  should  be  borne  in  mind  that  it 
is  an  extraordinary  occupation  in  an  extraordinary  atmosphere, 
and  only  extraordinary  men  should  be  employed.  They  should 
be  physically  above  the  average,  between  the  ages  of  twenty-one 
and  forty,  of  slender  build,  non-alcoholic,  and  with  absolutely 
sound  heart  and  lungs.  Any  variation  from  normal,  even  in  rate  or 
regularity  of  the  heart,  should  be  enough  to  reject  a  man.  No  man 
with  symptoms  of  any  organic  disease  should  be  passed. 

The  fight  for  slower  decompression  has  not  been  with  the  con- 
tractors so  much  as  with  the  employees  themselves,  and  I  do 
not  believe  that  the  reason  is  so  much  the  desire  on  the  part 
of  the  men  to  get  away  from  their  work  quickly  as  it  is  a  spirit 
of  bravado  that  prevails  with  nearly  all.  There  is  a  certain  con- 
tempt developed  for  the  air,  the  result  of  familiarity.  As 
they  say,  they  can  "eat  air".  Reason  and  a  few  painful  lessons, 
however,  have  diminished  this  spirit  to  a  great  extent  and,  by 
the  placing  of  responsible  men  in  the  position  of  lock-tender, 
we  have  been  able  to  regulate  the  time  to  much  better  advantage. 
Nearly  all  cases  are  caused  by  too  rapid  decompression,  and  my 
experience  has  been  that  where  the  decompression  has  been  slow 
no  serious  case  has  ever  resulted.  It  is  my  belief  that  if  a  suffi- 
ciently long  time  were  taken  for  decompression  we  would  never 
have  a  fatal  case  in  an  otherwise  healthy  man. 

The  time  that  should  be  taken  for  proper  and  scientific  de- 
compression depends  directly  on  the  amount  of  air  that  is  dis- 
solved by  the  blood  under  pressure.  And  the  amount  of  air  dis- 
solved by  the  blood  is  determined  by  (i)  the  length  of  time  spent 
in  the  air,  (2)  the  number  of  pounds  of  pressure,  and  (3)  the 
amount  of  exercise  undertaken  in  the  air.  A  lock-tender  may 
go  rapidly  in  and  out  of  very  high  pressure  with  no  ill  effects, 


AIR-LOCK  OX  TOP  OF  CAISSON 

IN    SINKING    FOUNDATIONS    FOR    SKYSCRAPING    BUILDINGS    MEN    Go    DOWN 
BENEATH  THE  WATER  LEVEL  AND  WORK  IN  COMPRESSED- 
AIR  CHAMBERS  OR  CAISSONS 

THE  AIR  PRESSURE  is  FREQUENTLY  MORE  THAN  THREE  TIMES  THE  NORMAL 
FIFTEEN  POUNDS  PER  SQUARE  INCH.     WORKERS,  IF  RELEASED  GRAD- 
UALLY DURING  DECOMPRESSION  IN  THE  AIR  LOCK,  AVOID  THE 
"BENDS",  OR  COMPRESSED-AIR  ILLNESS 


Compressed-Air  Illness  in  Caisson  Work  353 

as  his  stay  in  the  air  is  short.  Superintendents  and  engineers, 
whose  stay  is  shorter  than  that  of  a  regular  shift  and  who  do  no 
manual  labor  in  the  air,  do  not  suffer  from  the  "bends"  as  fre- 
quently as  do  the  diggers. 

In  addition  to  the  purely  mechanical  problem  as  a  causative  fac- 
tor, we  have  to  take  into  account  the  individual  susceptibility  to 
caisson  disease.  Five  men  of  apparently  the  same  physical  condition 
come  out  of  a  caisson  under  absolutely  the  same  conditions.  One 
of  the  five  is  attacked  by  the  affliction  and  the  other  four  are  unaf- 
fected. What  determines  this  susceptibility?  The  blood  of  each 
undoubtedly  dissolves  the  sam§  amount  of  air  under  pressure,  and 
when  the  pressure  is  reduced  the  air  comes  out  of  solution  in  pre- 
cisely the  same  length  of  time.  Authorities  differ  as  to  the  change 
in  pressure  in  the  vessels,  but  to  my  mind  this  is  a  real  and  impor- 
tant factor.  If  the  pressure  within  the  vessels  were  not  increased, 
the  blood  could  not  dissolve  the  air  or  hold  it  in  solution.  Conse- 
quently, in  rapid  decompression  we  have  not  only  to  deal  with  air  in 
the  form  of  small  emboli  in  the  blood  stream,  but  we  have  exerted 
against  the  vessel  walls  an  abnormal  pressure  which  has  not  had 
time  to  diminish  at  the  same  rate  as  the  air  in  the  air-lock.  The  ves- 
sel walls  of  the  man  in  good  condition,  or  rather  the  man  who  is  the 
good  risk,  are  able  to  counteract  this  pressure  and  carry  the  air  to 
the  lungs  where  it  is  expelled.  The  man  whose  vessel  walls  dilate 
under  this  pressure  is  not  able  to  get  rid  of  his  air  so  quickly,  and  the 
small  emboli  collect  in  sacculations  at  the  weaker  points  and  remain 
until  recompression  is  carried  out  so  that  the  air  is  again  taken  up 
in  solution  in  the  blood. 

For  my  own  convenience  I  have  classified  the  different  types  of 
the  disease  as  follows:  (i)  spinal  type;  (2)  cerebral  type;  and 
(3)  pulmonary  type.  Each  of  these  is  again  subdivided  into  (A) 
mild  variety,  and  (B)  severe  variety.  Of  the  spinal  type  the  mild 
variety  is  characterized  by  aching  pains  in  the  extremities ;  and  the 
severe  variety  by  paraplegia  and  general  weakness  but  no  pain.  Of 
the  cerebral  type  the  mild  variety  is  characterized  by  vertigo,  nausea 
and  some  prostration ;  and  the  severe  variety  by  coma,  usually  hemi- 
plegia,  and  great  prostration,  with  pulse  and  respiration  barely  per- 
ceptible. The  main  symptom  of  the  pulmonary  type,  which  is  seen 
less  frequently,  is  dyspnoea.  The  mild  variety  of  the  spinal  type 
never  results  fatally,  but  in  rare  cases  it  causes  a  wasting  of  the 


354  American  Labor  Legislation  Review 

muscles  of  the  thigh  by  a  gradual  process  which  involves  the  hip- 
joint  as  well.  The  severe  variety,  with  paralysis  of  the  legs,  never 
terminates  fatally  except  from  the  secondary  results  of  a  myelitis, 
where  treatment  has  been  of  no  avail.  The  milder  variety  of  the 
cerebral  type  is  due  probably  to  a  disturbance  of  the  internal  ear  and 
terminates  favorably;  but  the  severe  variety  of  the  cerebral  type, 
characterized  by  coma,  is  fatal  in  many  cases  in  spite  of  any  treat- 
ment that  may  be  instituted. 

In  regard  to  the  treatment  of  the  severe  cases,  everything  de- 
pends on  proper  and  skilful  recompression  in  the  hospital  lock. 
The  greatest  mistake  in  the  past  has  been  in  recompression  to  the 
number  of  pounds  in  which  the  patient  was  working.  This  is  abso- 
lutely unnecessary  and  is  highly  dangerous.  Uniformly  good 
results  are  obtained  by  recompressing  to  two-thirds  what  the  pres- 
sure was  in  the  working  chamber.  This  corresponds  in  some  meas- 
ure to  Dr.  Haldane's  theory  of  rapid  decompression  for  the  first 
stage.  When  the  desired  pressure  is  attained  it  is  wise  to  leave  it 
stationary  for  some  time,  according  to  the  merits  of  the  case  and  the 
improvement  of  the  patient.  In  all  cases  of  the  severe  type  the 
medical  attendant  should  be  recompressed  with  the  patient  and  it  is 
his  duty  to  use  artificial  respiration  if  necessary,  to  massage  over 
the  heart  with  movements  of  the  extremities,  and  in  many  cases  to 
force  the  mouth  open  and  promote  respiration.  When  consciousness 
returns  it  is  wise  to  encourage  the  patient  to  execute  voluntary 
movements  and  to  get  up  and  walk  in  the  lock,  allowing  him  to  rest 
at  intervals.  Decompression  in  patients  afflicted  with  the  milder  va- 
riety of  the  disease  can  be  carried  out  at  the  rate  of  about  one  pound 
in  four  minutes,  taking  one  hour  where  the  recompression  has  been 
to  15  Ibs.  In  the  severe  cases,  decompression  should  be  much 
slower,  at  the  rate  of  ten  to  twelve  minutes  for  a  single  pound, — 
that  is,  where  the  recompression  has  been  to  15  Ibs.  taking  as  long 
as  two  and  one-half  or  three  hours,  and  where  the  recompression 
has  been  to  20  Ibs.  taking  as  long  as  three  and  one-half  or  four 
hours. 

The  following  is  the  history  of  an  interesting  case  followed  by 
recovery : 

Name,    J—       -    M—    — .      Age    28.      Ht.    5    ft.    6    in.      Wt.    160    Ibs. 

History: — On  December  loth,  1909,  started  to  work  in  37  Ibs.  pressure 
without  ever  having  been  examined.  He  had  been  quite  ill  for  about  two 


Compressed-Air  Illness  in  Caisson  Work  355 

weeks  previously,  suffering  from  a  severe  cold.  Worked  for  two  hours,  al- 
though he  had  never  been  employed  in  compressed  air  before.  On  coming 
out  of  the  lock  was  decompressed  very  rapidly,  in  about  one  minute's  time, 
with  the  rest  of  the  gang.  He  fell  unconscious  and  was  carried  to  the  lock 
for  recompression. 

Treatment : — Was  at  once  recompressed  with  an  attendant  to  20  Ibs.,  and 
after  the  air  had  been  maintained  at  this  level  for  about  ten  minutes  re- 
covered consciousness  and  was  able  to  get  up  and  walk  about  in  the  lock. 
He  was  gradually  decompressed,  taking  a  period  of  two  hours.  On  exit 
from  the  lock  he  felt  pretty  well,  but  at  the  end  of  fifteen  minutes  again 
fell  over  unconscious  and  seemed  to  be  quite  lifeless.  He  was  again  recom- 
pressed with  myself  to  20  Ibs.  and  under  the  same  treatment  recovered  con- 
sciousness in  the  air.  His  pulse  was  weak  and  rapid,  pupils  dilated,  and 
body  covered  with  a  profuse  perspiration.  I  encouraged  him  to  sit  up,  after 
administering  strychnine  to  him  hypodermically.  Passive  movements  were 
carried  out  with  massage  and  two  and  one-half  hours  were  taken  for  de- 
compression. When  he  made  his  exit  from  the  lock  he  felt  fairly  well,  but 
was  noticeably  weaker  than  he  was  on  coming  out  the  first  time.  He  was 
allowed  to  rest  in  the  recovery  room  and  restoratives  were  administered  to 
him.  Five  hours  later  lie  said  he  felt  well  enough  to  get  up  and  walk 
around,  but  complained  of  some  dizziness.  He  was  standing  up  near  the 
hospital  lock  and  was  speaking  to  me  when  he  was  seized  with  a  violent 
convulsion  and  fell  over  in  my  arms.  He  was  again  recompressed  with  me 
to  a  pressure  of  22  Ibs.  and  the  pressure  was  maintained  at  that  level  for  an 
hour  before  he  fully  regained  consciousness.  During  that  time  I  was  using 
artificial  respiration  on  him,  his  jaws  held  open  with  a  mouth  gag  and  his 
tongue  drawn  forward.  It  was  almost  a  quarter  of  an  hour  before  he 
breathed  at  all  satisfactorily.  At  the  end  of  an  hour  he  could  answer  ques- 
tions but  only  in  an  indefinite  way,  and  he  had  a  well-marked  paresis  of  his 
left  side.  This  gradually  improved,  but  he  was  so  very  weak  that  he  was  in 
clined  to  lie  down.  He  wanted  to  sleep  continually.  We  released  him  very 
slowly  until  at  the  end  of  five  hours  decompression  was  complete.  This  was 
at  the  rate  of  one  pound  in  fourteen  minutes.  He  was  carried  to  the  re- 
covery room  and  by  that  time  had  recovered  entirely  from  the  coma  and 
paresis.  He  was  given  some  broth  and  was  allowed  to  sleep  for  three  hours. 
He  rested  for  two  hours  more  and  at  the  end  of  that  time  was  so  improved 
that  I  allowed  him  to  go  home. 

He  never  had  any  recurrence  and  was  able  to  come  around  for  his  pay 
three  days  later.  Two  weeks  later  he  was  in  apparently  good  health,  but  I 
advised  him  never  to  enter  even  the  slightest  pressure  again.  Neverthe- 
less, within  three  weeks  of  his  illness,  he  did  go  to  work  in  light  pressure 
in  another  part  of  the  city,  but  only  worked  a  few  days.  About  four  months 
later  he  had  an  attack  of  pneumonia  and  died. 


LEGAL  PROTECTION  FOR  WORKERS  IN  UNHEALTHFUL 

TRADES 


JOHN  B.  ANDREWS 
Secretary,  American  Association  for  Labor  Legislation. 


The  need  of  labor  legislation  for  the  protection  of  workers  in 
unhealthful  trades  is  so  apparent  to  anyone  at  all  familiar  with  the 
facts  that  argument  upon  the  subject  is  unnecessary.  "Factory 
legislation",  to  use  the  earlier  English  term,  has  aimed  particularly 
at  the  protection  of  workers  from  insanitary  conditions  of  employ- 
ment. Long  before  any  considerable  number  of  people  admitted  that 
legal  regulation  of  working  hours  and  of  wages  was  justifiable, 
there  was  very  general  recognition  of  the  fact  that  the  worker  was 
entitled  to  a  decently  safe  place  in  which  to  labor.  The  reasonable- 
ness of  sanitary  regulations  as  a  legitimate  interference  with  work 
conditions  prescribed  by  the  employer  and  suffered  by  the  employee, 
has  also  been  more  uniformly  upheld  by  the  courts  than  any  other 
kind  of  labor  legislation. 

In  general,  certain  trades  are  unhealthful  and  require  regulation 
principally  because  the  workrooms  under  ordinary  conditions  are 
likely  to  be  poorly  ventilated.  More  specifically,  the  harmful  condi- 
tions of  employment  are  frequently  due  to  the  presence  of  dusts, 
gases,  vapors,  and  fumes ;  to  extremes  of  temperature,  humidity,  or 
density  of  the  atmosphere ;  and  to  improper  lighting  and  overstrain. 

The  evil  results  of  unhealthful  conditions  have  long  been  recog- 
nized, and  in  every  industry  there  are  humane  and  intelligent  em- 
ployers who  devote  much  time  and  money  to  the  elimination  of  un- 
necessary hazards.  Whether  prompted  by  humanitarian  or  commer- 
cial considerations,  these  advanced  employers  frequently  provide 
model  establishments.  By  their  commendable  efforts  they  also  help 
to  establish  reasonable  standards  of  comfort  and  safety  which,  when 
drafted  into  labor  law,  constitute  uniform  minimum  requirements 
for  all  employers  in  the  same  industry.  But  only  through  the  uni- 
formity of  regulation  which  legal  enactments  alone  can  secure,  can 
these  more  progressive  and  humane  employers  be  themselves  pro- 


Legal  Protection  for  Workers  in  Unhealthful  Trades      357 

tected  from  less  scrupulous  competitors  who  would  otherwise  often 
fail  to  go  to  the  expense  of  providing  adequate  safeguards,  and 
only  through  such  compulsory  uniformity  can  the  health  of  the  em- 
ployees of  these  competitors  be  protected. 

It  frequently  happens,  moreover,  that  even  a  vast  majority  of  the 
manufacturers  in  a  given  industry  claim  that  they  are  unable  to 
bring  about  reforms,  which  they  freely  admit  are  desirable,  without 
the  aid  of  uniform  legal  regulations  to  force  the  recalcitrant  mi- 
nority into  line.  A  striking  example  of  this,  the  condition  which 
culminated  successfully  in  the  poisonous  phosphorus  match  pro- 
hibition act,  is  still  fresh  in  the  public  mind.  Match  manufacturers, 
representing  ninety-five  per  cent  of  the  total  product,  testified  before 
Congress  that  they  could  not  substitute  a  harmless  compound  for 
the  slightly  cheaper  poison  without  a  uniform  law  compelling  all 
manufacturers  in  that  industry  simultaneously  to  abandon  the  poi- 
son. Match  manufacturers  representing  the  remaining  five  per 
cent  of  the  product  stood  out  stoutly  until  the  last,  declaring  that 
they  would  close  their  factories  before  they  would  submit  to  this 
sanitary  regulation  already  in  compulsory  operation  in  practically 
all  the  civilized  countries  of  the  world.  It  required  labor  legislation 
to  prohibit  the  use  of  this  unnecessary  deadly  poison  before  "phossy 
jaw",  the  most  loathsome  of  all  industrial  diseases,  could  be  abol- 
ished. 

For  other  industrial  poisons  there  are  harmless  but  more  ex- 
pensive substitutes.  Automatic  mechanical  processes  can  be  sub- 
stituted for  dangerous  methods  still  conducted  by  hand  labor.  Scores 
of  operations  in  the  present  list  of  particularly  insanitary  trades 
can  be  made  safe  by  the  use  of  scientific  apparatus  for  the  removal 
of  dangerous  dusts  and  fumes. 

The  unhealthful  trades  demanding  legal  regulation  may  be  con- 
veniently classified  according  to  the  nature  of  the  principal  hazards : 

(1)  Trades  menaced  by  specific  industrial  dusts,  fumes,  gases, 
vapors  and  acids  (poisonous  and  non-poisonous)  ; 

(2)  Trades  menaced  by  compressed  or  rarified  atmospheres; 

(3)  Trades  menaced  by  improper  light; 

(4)  Trades  menaced  by  extremes  of  temperature  and  humidity; 

(5)  Trades  menaced  by  excessive  strain. 

Hundreds  of  peculiar  injuries,  caused  by  these  unhealthful  con- 
ditions of  employment,  are  now  beginning  to  receive  serious  atten- 


358  American  Labor  Legislation  Review 

tion  in  America  as  special  diseases  of  occupation.  This  new  line 
of  study  is  most  encouraging  to  those  interested  in  securing  effective 
legal  regulation  of  unhealthful  trades,  because  it  has  long  been  recog- 
nized by  the  people  most  familiar  with  the  facts  that  specific  studies, 
leading  to  the  establishment  of  more  definite  standards  of  safety,  are 
necessary  before  much  even  of  the  now  existing  legislation  can  be 
effectively  enforced. 

While  such  researches  are  under  way,  we  should  emphasize  at 
every  opportunity  the  following  considerations :  ( I )  All  preventable 
occupational  diseases  must  be  prevented;  (2)  those  occupational 
diseases  which  we  do  not  yet  know  how  to  prevent  must  be  reduced 
to  a  minimum;  and  (3)  the  victims  of  occupational  disease  must  be 
compensated  for  their  injuries  by  some  just  system  of  insurance. 

Efforts  to  carry  out  this  program  lead  naturally  to  three  principal 
methods : 

(1)  Absolute  prohibition. — Through  the  successful  outcome  of 
the  efforts  to  secure  a  prohibitory  tax  upon  matches  made 
with  poisonous  phosphorus,  an  avenue  of  tremendous  possi- 
bilities, if  carefully  followed  and  not  abused,  is  opened  up 
for  the  further  conservation  of  human  life. 

(2)  Regulation. — There  may  be  specific  or  general  regulations: 
A. — Specific  regulation. — For  the  sake  of  clearness  we  may 
recall,  as  an  illustration  of  specific  regulation,  the  earlier  his- 
tory of  the  match  industry,  when  several  countries,  before 
harmless    substitutes    for   poisonous   phosphorus    were    dis- 
covered, attempted  to  prevent  "phossy  jaw"  by  requiring,  (a) 
that  match  paste  should  contain  not  more  than  seven  per  cent 
of  the  deadly  poison;  (b)  that  no  one  should  be  permitted 
to  work  in  the  poisoned  atmosphere  of  a  match  factory  more 
than  eight  hours  in  any  one  day,  and  (c)  that  children  should 
not  be  so  exposed.  There  were,  then,  in  this  intermediary  pe- 
riod of  specific  regulation,  three  definite  limitations,  (i)  upon 
the  hazardous  material,  (2)  upon  the  period  of  exposure,  and 
(3)  upon  the  persons  exposed.     By  this  method  of  specific 
regulation  also  there  are  extensive  possibilities  for  legal  regu- 
lation in  the  interest  of  human  health. 

B. — General  regulation. — This  method  is,  unfortunately,  the 
most  common.  If,  again,  for  the  sake  of  clearness,  we  make 
final  use  of  the  match-factory  illustration,  we  recall  that  be- 


Legal  Protection  for  Workers  in  Unhealthful  Trades      359 

fore  prohibition  was  thought  of  and  before  specific  regulation 
had  been  tested,  most  countries  had  made  vague  efforts, 
through  general  regulations,  to  provide  education,  ventilation, 
and  cleanliness  for  the  promotion  of  the  comfort  and  health 
of  workers  in  match  factories.  This  general  method  lends 
itself  most  readily  to  that  large  group  of  trades  in  which  the 
occupational  causes  of  industrial  maladies  are  least  clearly 
defined.  It  marks  the  earliest  stage  of  regulation  where,  on 
account  of  complex  conditions  of  employment,  we  are  still 
feeling  our  way  in  partial  darkness  without  definite  standards 
for  our  guidance. 

(3)  Insurance. — It  is  now  recognized  that  the  campaign  for  work- 
men's compensation  or  insurance  for  industrial  accidents,  both 
in  Europe  and  in  America,  has  been  the  greatest  practical 
force  in  the  prevention  of  such  injuries.  No  intelligent  per- 
son can  go  far  in  the  study  of  insurance  against  industrial 
accidents  without  realizing  that  a  logical  consideration  of  the 
facts  must  lead  likewise  to  insurance  against  industrial  dis- 
eases. A  workman,  incapacitated  by  disease  contracted  in 
his  trade  and  due  to  his  employment,  is  as  much  entitled  to 
compensation  as  if  he  had  been  disabled  by  an  accident.  In 
many  European  countries  this  principle  is  already  established. 

In  all  attempts  to  control  dangerous  trades,  the  method  of  general 
regulation  has  naturally  preceded  specific  regulation  and  absolute 
prohibition  as  well  as  insurance.  On  paper  it  is  by  far  the  easiest, 
and  unfortunately  it  creates  a  temporary  impression  of  accomplish- 
ment which  is  quite  fascinating  to  the  occasional-day  reformer.  It  is 
probably  a  necessary  first  step  in  most  industries  where  definite,  en- 
forceable, scientific  standards  must  wait  upon  investigation  and  prac- 
tical experiment. 

In  attempting  to  deal  intelligently  with  these  problems,  our  bill 
drafters  are  hopelessly  baffled  by  the  lack  of  scientific  standards. 
And  nothing  is  more  clear  to  serious  students  of  the  subject  than 
the  unavoidable  conclusion  that  effective  laws  for  the  regulation  of 
unhealthful  trades  cannot  be  properly  drafted  by  busy  and  harassed 
legislators  in  the  midst  of  legislative  sessions.  In  the  field  of  in- 
dustrial hygiene,  no  greater  contribution  could  be  made  at  the  present 
time  than  the  establishment,  by  a  commission  of  experts,  of  such 
standards. 


360  American  Labor  Legislation  Review 

The  existing  laws  in  this  country  for  the  regulation  of  factory 
labor  in  the  interest  of  the  comfort  and  health  of  the  workers  are 
for  the  most  part  formulated  on  general  lines, — confused,  indefinite, 
and  full  of  loopholes.  In  the  fifteen  states  which  even  pretend  to 
protect  workers  from  the  effects  of  poisonous  gases,  fumes,  and 
vapors,  the  laws  seldom  give  more  definite  directions  than  that  such 
dangerous  gases,  fumes,  and  vapors  must  be  removed  or  rendered 
harmless  "when  injurious  to  the  health  of  employees",  or  "so  far  as 
practicable",  or  "if  necessary".  In  one  state  the  law  sweepingly 
provides  for  all  health  protection  by  stating  that  the  factory  inspect- 
or "shall  also  examine  into  the  sanitary  conditions  of  factories, 
workshops,  mines  and  quarries,  and  when  any  condition  or  thing  is 
found  that  in  his  opinion  endangers  the  health  or  lives  of  the  em- 
ployees, he  shall  notify  and  direct  the  employer  to  rectify  the  same." 
This  class  of  statute  law,  which  is  quite  common,  places  no  duty 
upon  the  employer  to  provide  proper  protection  until  he  is  ordered 
to  do  so  by  the  inspector.  When  one  considers  the  area  to  be  covered 
in  our  large  industrial  states,  and  the  number  of  workplaces  to  be 
inspected,  it  can  easily  be  seen  that  workers  depending  for  their 
safety  upon  the  specific  orders  of  a  limited  number  of  inspectors  are 
likely  to  receive  entirely  insufficient  protection  from  laws  of  this 
character. 

Although  work  in  compressed  air  has  become  an  important  element 
in  the  building  trades  of  this  country,  New  York  is  still  the  only 
state  which  has  a  scientific  law  relating  to  work  of  this  character. 

There  are  only  twelve  states  that  make  any  mention  of  the  sub- 
ject of  light  in  their  general  factory  or  labor  laws.  And  "in  not 
one  of  these",  says  a  well-known  efficiency  engineer,  "are  the  pro- 
visions sufficiently  specific  to  render  them  of  practical  value." 

Laws  intended  to  protect  the  workers  from  injurious  dusts  in  fac- 
tories have  been  enacted  in  twenty  states,  but  they  are  generally  very 
crude  and  in  practice  more  or  less  ineffective.  "Drastic  legal  re- 
quirements alone",  says  the  leading  American  authority  on  this  sub- 
ject, "are  certain  to  bring  about  the  re'quired  degree  of  comfort 
and  health." 

One  reason  that  many  safe  methods  are  not  in  operation  at  the 
present  time  is  simply  that  many  employers,  busy  with  the  making  of 
profits,  have  had  no  sufficient  incentive  to  turn  their  attention  to 
factory  sanitation;  and  another  reason  is  that  state  factory  inspect- 


"SEPARATING  SCREENS"  IN  WHITE-LEAD  FACTORY 
A  ONCE  DUSTY  PROCESS  Is  HERE  MADE  PRACTICALLY  FREE  FROM  LEAD  DUST 
BY  THE  USE  OF  ENCLOSED  CHURN-LIKE  MACHINES  WHICH  SIFT 
THE  METAL  FROM  THE  CORRODED  WFIITE  LEAD 


Legal  Protection  for  Workers  in  Unhealthful  Trades      361 

ors  have  not  always  been  fully  aware  of  their  opportunities  and 
responsibilities.  The  motive  which  leads  some  intelligent  employers 
properly  to  equip  their  plants  with  safeguards  is  undoubtedly  the 
conviction  that  it  increases  the  efficiency  of  their  workmen.  There 
is  abundant  testimony  to  that  effect  from  the  rapidly  rising  profes- 
sion of  efficiency  engineers  and  from  their  patrons.  But  even  the 
most  enthusiastic  "boosters  for  safety"  among  the  thoughtful  effi- 
ciency experts  recognize  the  absolute  necessity  for  the  establishment 
of  uniform  legal  standards  of  safety  if  the  health  of  the  great 
majority  of  factory  workers  is  to  be  conserved. 

Recently  a  few  of  the  less  though ful  enthusiasts  in  the  popular 
agitation  for  efficiency  have  failed  to  get  the  true  perspective  and 
have  clamored  for  protection  for  the  workers  solely  upon  the  ground 
that  "it  pays"  the  employer.  Let  us  congratulate  ourselves  that 
those  who  are  in  danger  of  losing  their  health  and  their  lives  in  their 
daily  toil  have  in  some  instances  at  least  that  incidental  advantage. 
But  let  us  have  less  of  this  everlasting  dinning  in  our  ears  that,  be- 
fore we  ask  for  decent  protection  for  the  workers,  we  must  first 
demonstrate  that  each  advance  toward  health  and  safety  will  actually 
put  additional  dollars  in  the  pockets  of  employers.  Let  no  one  for- 
get, meanwhile,  that  the  philosophy  of  mercenary  profit,  when  carried 
to  its  logical  conclusion,  may  result  in  some  instances,  where  it  is 
not  clear  that  profits  will  respond  immediately  to  the  expense  of 
safety,  in  less  than  decent  protection.  No  man  in  this  Republic 
should  be  permitted  for  a  moment  to  forget  that,  no  matter  how 
urgent  is  the  duty  to  protect  the  property  of  citizens,  society  has  a 
much  higher  responsibility,  the  protection  of  human  life. 

In  our  efforts  to  secure  the  necessary  information  upon  which  to 
base  intelligent  legislation,  we  must  draw  more  and  more  upon  the 
expert  service  of  the  physician.  Eight  states  have  already  enacted 
laws  requiring  medical  reports  on  the  most  easily  recognizable  dis- 
eases of  occupation.  These  reports  will  indicate  special  danger 
points  for  intensive  study  within  industrial  establishments. 
Periodical  physical  examination  of  workers  in  particularly  hazard- 
ous trades  is  now  required  in  one  state,  and  the  regular  medical  in- 
spection of  factories,  now  unhappily  limited  to  three  states,  will 
undoubtedly  be  extended  rapidly  within  the  near  future.  Medical 
colleges  might  well  include  regular  courses  on  industrial  hygiene; 
hospitals,  too,  will  be  expected  to  improve  their  system  of  records ; 


362  American  Labor  Legislation  Review 

and  in  the  leading  industrial  centers  we  shall  eventually  have  special 
clinics  and  wards  for  the  study  and  prevention  of  industrial  dis- 
eases. Recent  developments  indicate  that  the  medical  profession  will 
not  evade  its  opportunity  and  responsibility. 

For  many  years  it  has  been  our  shame  that  in  this  field  we  have 
lagged  far  behind  some  of  the  countries  of  Europe.  Our  scandalous 
disregard  for  the  safety  and  health  of  workers  is  widely  known. 
But  in  this  country  true  reform  waits  not  so  much  upon  sentiment 
as  upon  facts.  We  are  just  beginning  to  utilize  the  materials  at 
hand,  and  our  machinery  for  scientific  cooperation  in  promoting  in- 
dustrial hygiene  is  but  fairly  set  in  motion.  We  move  rapidly  when 
once  under  way.  Let  us  press  on  in  the  hope  that  another  generation 
may  see  America  leading  the  nations  of  the  world. 


GENERAL  DISCUSSION 

DR.  C.  T.  GRAHAM-ROGERS,  Medical  Inspector  of  Factories,  New 
York:  Any  discussion  of  the  question  of  state  promotion  of  indus- 
trial hygiene  would  comprise  four  points,  first  the  reporting  of 
industrial  diseases,  second  the  recording  of  the  reports,  third  in- 
tensive study  of  the  means  of  prevention,  and  fourth  education. 
The  departments  of  state  which  would  naturally  be  responsible 
would  be  the  health  department/the  labor  department,  and  the  educa- 
tional department. 

Dr.  Wilbur  has  spoken  of  how  the  question  of  reporting  corre- 
sponds to  the  registration  of  births.  The  notification  of  industrial 
diseases  gives  us  some  idea  of  how  to  make  an  investigation  and  then 
of  how  to  prevent  further  trouble.  The  morbidity  returns  are  more 
important  than  the  mortality  returns.  Last  year  I  went  over  the 
reports  of  New  York  State  and  I  noticed  that  the  mortality  from 
pulmonary  tuberculosis  in  a  locality  known  for  steel  grinding  ap- 
peared to  be  low,  while  in  an  essentially  country  district  it  appeared 
to  be  very  high.  I  have  visited  every  factory  in  the  state  and,  from 
the  known  facts  that  I  have  of  the  steel  district,  these  statistics  are 
no  indication  whatever  of  the  real  conditions.  In  foreign  coun- 
tries the  records  are  more  complete. 

In  New  York  State  the  reports  of  occupational  diseases  are  sent 
to  the  bureau  of  labor  statistics.  Dr.  Hatch  of  that  bureau 
then  sends  me  a  copy  of  every  report  that  is  made.  These  cases  are 
followed  up  and  when  they  run  up  to  a  certain  number  in  an  indus- 
try we  start  an  intensive  investigation.  We  try  to  find  the  cause 
of  the  occupational  disease,  whether  it  is  due  to  dust,  to  fumes,  to 
gases,  or  to  atmospheric  conditions.  We  try  to  find  the  exact 
point  in  the  industry  that  is  to  blame.  We  have  in  New  York  an 
engineering  inspector  who  takes  up  the  matter  with  the  medical  in- 
spector whenever  it  is  a  question  of  mechanical  means  for  the  re- 
moval of  dust,  fumes,  and  gases. 

The  state  labor  department  can  also  take  up  the  question  of  the 
home  worker  and  of  the  child  worker.  In  the  promotion  of  indus- 
trial hygiene  it  is  an  important  thing  to  know  whether  or  not  a 
child  is  fit  to  go  into  an  industry.  If  a  child  is  not  fit  to  go  into 


364  American  Labor  Legislation  Review 

a  certain  industry  we  should  keep  him  out.  The  educational  de- 
partment can  help  in  this  work  by  vocational  schools,  by  finding  out 
what  the  children  are  fit  for,  and  by  teaching  them  that  there  are 
certain  means  to  protect  their  health  and  lives  and  how  to  use  these 
means. 

Dr.  Overlock,  in  taking  up  the  question  of  education,  has  em- 
phasized the  instruction  of  physicians  in  medical  colleges  to  under- 
stand and  know  industrial  diseases  when  they  see  them.  I  think 
that  is  most  important.  I  myself  had  an  example  of  the  need  for 
such  instruction.  I  went  into  a  factory  where  they  made  storage 
batteries  and  one  of  the  workers  there  had  a  typical  case  of  lead 
poisoning  and  wrist-drop.  I  asked  the  foreman  if  he  had  known 
anything  of  lead  poisoning.  He  said  no,  that  the  individual  just 
hung  around  there,  suffering  from  rheumatism  and  one  thing  and 
another,  and  that  it  was  a  matter  of  charity  to  let  him  do  little  jobs. 
I  asked  the  worker  if  he  had  been  to  a  physician  and  found  that 
he  was  being  treated  for  rheumatism.  He  was  in  the  vicinity  of  the 
Vanderbilt  Clinic,  so  I  gave  him  a  card  and  sent  him  over  there.  It 
was  a  well-marked  case  of  lead  poisoning  and  not  rheumatism.  So 
the  statement  made  by  Dr.  Overlock  is  true.  Some  of  the  medical 
men  are  not  instructed  and  do  not  see  enough  cases  to  be  able  to 
recognize  these  diseases. 

MR.  PAUL  KENNADAY,  Secretary,  New  York  Association  for 
Labor  Legislation,  New  York  City:  I  liked  particularly  Dr.  Over- 
lock's  suggestion  with  regard  to  tuberculosis.  A  tuberculosis  cam- 
paign furnishes  us  with  a  standard  for  the  whole  question  of  indus- 
trial disease.  What  the  people  who  are  fighting  tuberculosis  have 
done  it  seems  to  me  we  should  do  with  industrial  diseases  in  general. 
The  exhibition,  the  lecture,  the  printed  leaflet,  and  the  newspaper 
have  all  been  used  with  great  success  in  that  campaign,  and  we 
should  use  the  same  means  in  the  matter  of  industrial  diseases. 

We  must  get  this  thing  over  to  the  public.  We  must  make  them 
realize  that  there  is  a  relation  between  occupation  and  disease,  and 
we  must  not  be  overnice  in  the  way  we  go  about  it.  In  Massachu- 
setts they  say  that  at  one  time  there  was  a  sign  in  Boston  which 
stated  that  the  public  was  requested  not  to  deposit  sputum  upon  the 
pavements.  We  said  in  New  York,  a  more  vulgar  lot,  "Don't  spit", 
and  I  think  the  message  carried  over  rather  better. 


General  Discussion  365 

It  is  the  same  with  regard  to  industrial  diseases.  We  are  dealing 
with  people  many  of  whom  are  not  very  intelligent,  who  are  rushed 
with  their  occupations,  and  who  have  no  time  for  study,  and  we  must 
make  this  message  to  them  just  as  brief  and  just  as  vivid  as  possible. 
We  must  use  the  picture  to  a  large  extent  and  we  must  use  the  ex- 
hibition. We  ought  to  have  in  every  large  city  in  this  country  a 
permanent  industrial  exhibition  open  day  and  night,  especially  on 
Sundays  and  holidays,  for  the  education  of  the  worker  as  well  as 
the  manufacturer.  Then  we  should  make  use,  it  seems  to  me,  of 
the  motion  picture.  There  are  infinite  possibilities  there  for  driving 
home  this  lesson  of  prevention. 

We  must  remember,  too,  that  we  must  educate  not  only  the  indus- 
trial worker  but  the  physician.  If  we  are  to  believe  the  physicians 
themselves,  this  latter  job  is  probably  more  difficult  than  the  former. 
The  physician  looks  rather  askance  on  anything  new  and  he  is  fear- 
ful of  reformers.  We  must  gain  his  confidence  and  we  must  not 
be  overstrenuous  in  our  desire  to  force  this  registration  law.  In 
New  York  City  the  law  compelling  registration  of  tuberculosis  was 
first  put  on  the  books,  then  physicians  were  notified  of  it,  then  lec- 
tures were  given ;  and  the  thing  was  worked  up  gradually  among  the 
people  until  it  came  finally  to  actual  enforcement.  By  that  time 
the  law  had  the  good-will  of  the  majority  of  the  medical  profession. 

The  same  method  should  be  applied  to  the  reporting  of  occupa- 
tional diseases  in  general.  But,  finally,  the  whole  thing  is  up  to  the 
state  labor  departments  and  not  to  reformers  or  welfare  workers  or 
employees.  Our  public  officials  are  put  there  to  do  the  job  for  us. 
They  are  our  representatives,  the  representatives  of  the  great  body 
of  the  public,  of  the  trade  unionists  and  also  of  the  men  who  are  not 
organized  but  who  are  still  part  of  the  people.  It  is  up  to  all  of  us  to 
see  that  our  public  officials  do  their  work  honestly  and  with  a  cer- 
tain amount  of  vision,  that  they  do  not  just  stick  to  the  strict  letter  of 
the  law  but  go  out  and  do  the  thing  in  a  whole-hearted,  splendid  way. 
In  order  that  they  may  do  that,  it  is  up  to  us  to  see  that  they  get  suf- 
ficient appropriations,  that  they  are  able  to  pay  sufficient  salaries  so 
that  they  can  get  and  retain  the  right  sort  of  men,  and  that  they  in- 
sist upon  efficiency  and  do  not  countenance  the  retention  in  office 
of  men  who  simply  want  to  hang  on  to  good  political  jobs. 

PROFESSOR  HENRY  W.  FARNAM,  Chairman:    I  think  that  the  form 


366  American  Labor  Legislation  Review 

in  which  the  topic  "State  Promotion  of  Industrial  Hygiene",  is  put, 
is  calculated  to  awaken  in  the  minds  of  many  people  a  certain  pre- 
sumption against  the  proposition.  When  we  talk  of  the  state  I 
think  we  are  very  apt  to  have  in  mind  the  old  police  state.  'The 
state,  I'm  the  state."  We  sometimes  forget  that  we  are  the  state,  that 
the  state  is  all  of  us  in  a  democracy.  The  only  question  is  whether 
this  matter  of  industrial  hygiene  is  sufficiently  important  for  all  of  us 
to  get  together  to  try  and  put  something  through  or  whether  it 
is  a  matter  which  can  be  safely  left  to  the  individual. 

We  have  in  our  country  a  very  good  precedent  for  the  action  of 
the  government  in  these  matters.  In  the  first  decade  after  the  adop- 
tion of  the  Constitution  the  government  established  a  sick  insurance 
and  benefit  fund  for  seamen.  It  was  one  of  the  first  systems  of 
the  kind  in  the  world.  Here  was  a  case  where  the  government 
singled  out  a  single  profession  or  occupation,  known  to  be  particu- 
larly hazardous,  and  took  extraordinary  measures  to  provide  for 
sickness.  The  remarkable  thing  is  that  in  those  early  and  simpler 
days  apparently  no  one  ever  thought  to  contest  the  constitutionality 
of  that  measure,  and  the  consequence  was  that  it  went  on  and  we 
have  developed  a  great  medical  system,  the  United  States  Public 
Health  and  Marine-Hospital  Service,  out  of  that  small  beginning 
which  was  an  effort  by  the  government  to  provide  for  the  health  of 
one  particular  occupation. 

In  connection  with  the  very  valuable  suggestion  thrown  out  by 
Dr.  Overlock  with  reference  to  the  establishment  of  hospitals  for 
industrial  diseases,  it  may  be  well  to  state  that  Dr.  Devoto  of  Milan 
is  expected  to  be  in  this  country  in  September  in  attendance  at  the 
International  Congress  on  Hygiene  and  Demography  and  I  am  sure 
I  voice  the  sentiments  of  the  Association  in  saying  that  we  second 
heartily  Dr.  Overlock's  suggestion  and  hope  that  someone  who  has 
money  to  give  away  wisely  will  establish  such  a  hospital. 


V 

BIBLIOGRAPHY  ON  INDUSTRIAL  HYGIENE 


TRIAL  LIST  OF  REFERENCES 

ON 
OCCUPATIONAL  DISEASES  AND  INDUSTRIAL   HYGIENE 

Prepared  by  the 

AMERICAN  ASSOCIATION  FOR  LABOR  LEGISLATION 

UNITED  STATES  BUREAU  OF  LABOR 

LIBRARY  OF  CONGRESS 


WORKERS 


WHITE-LEAD  FACTORY 


REMOVING  CORRODED  WHITE  LEAD  FROM  JARS  IN  WHICH  IT  HAS  BEEN  TRANS- 
FORMED FROM   METALLIC  PLATES  BY  THE  ACTION  OF  ACETIC  ACID. 
IMPROVISED  RAG  MUZZLES  THE  ONLY  PROTECTION  FROM 
DEATH  DEALING  DUST 


BIBLIOGRAPHY  ON  INDUSTRIAL  HYGIENE 


This  preliminary  list  of  titles  is  here  printed  in  the  hope  that  it  may 
be  found  immediately  useful  to  the  rapidly  growing  group  of  Ameri- 
cans intelligently  interested  in  industrial  hygiene.  Additions  will  be 
made  to  this  list  during  the  year.  Copies  of  all  publications  on  the 
subject  are  therefore  urgently  solicited  in  order  that  from  this  beginning 
there  may  be  prepared  a  comprehensive  bibliography,  conveniently  ar- 
ranged and  classified  and  fully  annotated,  for  the  guidance  of  all  who 
wish  to  make  future  work  still  more  effective. 


AMERICAN  TITLES 

Addams,  Jane,  Hamilton,  Alice.     The  ........  Caisson     disease;     illustrated 

"piece-work"  system  as  a  factor  in  with  pen  drawings  of  caisson,  tunnel, 

the    tuberculosis    of    wage-workers.  shaft      and      drift,      air-locks,      etc. 

(Transactions  of  the  Sixth  interna-  (Cleveland  medical   gazette,    March 

tlonal     congress     on     tuberculosis,  1899,   v.    14:279-287.     Discussion,   p. 

Washington,  1998,  v.  3:139-140.)  287-295.) 

The  effect  of  fatigue  from  "speeding  up".  General   discussion    of   symptoms,    causes, 

Adler,  L.  H.,  Jr.     Report  of  a  case   of  theories,   etc.,  with  account  of  cases  in  Ar- 

chronic         mercurial          poisoning.  ansas. 

(American  lancet,   Detroit,   1890,  n.  .......  .Compressed-air  illness,  orcais- 

s    v    14*  161  )  son  disease.     (Medical  news,  N.  Y., 

General    discussion    of    mercurial    tremor  1904,  V.  85:1020-1024.      Illustrated.) 

and  account  of  a  case  in  a  hatter.  Based    on   study    of    50    cases    of    caisson 

A     report     of     five     cases     of  disease  occurring  in  the  water  tunnel  under 


chronc  mercurial  poisoning.    (Med-  ^ake.  Erie 

ical  news,  Philadelphia,  1891,  v.  59:  where. 

186-188.     Also  reprint.)  Alger,    Ellice    M.      Occupational    eye 

All  in  hat  factory  workers.                    .  diseases.      (American   labor   legisla- 

Agnew,  C.  R.    A  preliminary  analysis  tjon  review,  June  1912,  v.  2,  no.  2: 

of  i,  060  cases  of  asthenopia.     New  223-230.) 

York,  1877-     12  p  Allen,  J.  W.     On  the  need  of  a  pro- 

•J'&SAK'SJS  and  W°"  fressive  *^y  of.  industrial  diseases. 

Alcohol.    Hearings  on  free  alcohol  be-  (Chicago   magazine   times,    1907,   v. 

fore    the    Committee    on    ways    and  40:641-649.) 

means  of  the  House  of  representa-  American  Association  for  Labor  Leg- 

tives,  February-March,  1906,  ist  ses-  islation.     First   national   conference 

sion,    59th    Congress.      Washington,  on     industrial     diseases.       Chicago, 

government    printing    office.      1906.  J11116/?'  IQI°-    American  association 

430  p  for    labor    legislation,    New    York, 

Testimony  upon  the  effects  of  wood-alco-  1910,     52     p.        (Publication     no.     IO. 

hoi  on  the  health  of  workmen.    See  Index,  American  association  for  labor  leg- 

"Health",  p.  436.  islation.)     (See  Farnam,  Favill,  An- 

Aldnch,   Charles  J.     Trap-drummer's  dre         Henderson,    Hamilton,    and 

neurosis:  a  hitherto  undescribed  oc-  Hoffman  ) 

cupational  disease.     (Medical  news,  Second  national  conference  on 


American  Labor  Legislation  Review 


islation  review,  v.  2,  no.  2,  p.  179-417. 
(See  Thompson,  Keays,  Fordyce, 
Dana,  Alger,  Edsall,  Seager,  Hoff- 
man, Hatch,  Pratt,  Cabot,  Winslow, 
Baskerville,  Price,  Overlock,  Wilbur, 
Gibson,  Ryan,  and  Andrews.) 

American  labor  legislation  re- 
view, v.  i,  no.  I  (see  Hamilton, 
Schwab,  Hoffman,  and  Memorial  on 
occupational  diseases).  (Discussion 
of  reporting  of  diseases  by  employ- 
ers, medical  inspection  of  factories, 
clinic  for  industrial  diseases,  mer- 
curial poisoning  in  New  York  and 
New  Jersey,  etc.,  p.  73-95-) 

v.  i,  no.  2  (see  Hoff- 
man, Winslow,  Elliott,  Graham- 
Rogers,  and  Laws.) 

. . v.  i,  no.  3  (see  Laws). 

v.  i,  no.  4  (see  An- 
drews). (Discussion  of  occupational 
disease  reports,  p.  111-137.) 

v.  2,  no.  i   (see  Hotch- 

kiss.) 

Leaflets,  nos.  1-6. 

Ameirican  museum  of  safety,  Njew1 
York.  Safety  manual  no.  3.  Foun- 
dry practice.  Dangers  to  health  in 
the  molding  industry.  1912.  44  p. 
Ames,  Azel,  Jr.  Sex  in  industry:  a  plea 
for  the  working  girl.  Boston.  Os- 
good  and  company.  1875.  158  p. 

A  popular  treatment  of  the  results  of  the 
investigation  into  special  effects  of  certain 
forms  of  employment  upon  female  health, 
published  in  the  Sixth  Annual  Report  of  the 
(Mass.)  Bureau  of  Statistics  of  Labor  (q.  v.) 
by  the  physician  who  made  the  investiga- 
tion. 

Andrews,  John  B.  Phosphorus  poi- 
soning in  the  match  industry  in  the 
United  States.  (U.  S.  Bureau  of 
labor,  Bulletin  no.  86,  Jan.  1910,  p. 
3I-I44.) 

Based  on  thorough,  original  investigation 
of  15  out  of  the  16  match  factories  in  the 
United  States. 

Deaths    from    industrial    lead 

poisoning  (actually  reported)  in 
New  York  state  in  1909  and  1910. 
(U.  S.  Bureau  of  labor,  Bulletin  no. 
95,  July  1911,  p.  260-282.) 

A  personal  investigation  of  60  deaths  re- 
ported by  physicians  as  due  to  lead  poison- 
ing. 

Phosphorus  poisoning  in  the 

manufacture  of  matches.  (American 
association  for  labor  legislation, 
1910.  Publication  no.  10:  11-19.) 

Brief  general  discussion  based  on  report 
for  United  States  Labor  Bureau  (q.  v.). 


The  beginning  of  occupational 

disease  reports.  (American  labor 
legislation  review,  Dec.  1911,  v.  i, 
no.  4:  107-113.  Discussion,  p.  ui- 

I37-) 

Reasons  for  and  main  provisions  of  laws 
passed  in  six  states  in  1911. 

Legal  protection  for  workers 

in  unhealthful  trades.  (American 
labor  legislation  review,  June  1912, 
v.  2,  no.  2:356-362.) 

Industrial  diseases  and  occu- 
pational standards-.  (Proceedings 
of  the  National  conference  of  chari- 
ties and  corrections,  37th  session, 
May  1910,  p.  440-449.  Reprinted  as 
pamphlet.) 

Protection  against  occupation- 
al diseases.  (Academy  of  political 
science,  New  York,  v.  2,  no.  2:  18- 
23.) 

Industrial  diseases  and  physi- 
cians. (Journal  of  American  medical 
association,  April  15,  1911,  v.  56: 
1132-1134.) 

Beginning      of      occupational 

disease  reports.  (Journal  of  Ameri- 
can medical  association,  Dec.  16, 
1911,  v.  57:  1984-1986.) 

. .! Diseases  of  occupation.     (The 

physician,  Aug.  1911,  p.  9-15.  Ameri- 
can federationist,  June  1911,  p.  455- 
457-) 

Industrial    diseases    problem. 

(Proceedings  of  the  National  con- 
ference of  charities  and  corrections, 
39th  session,  June  1912.) 

Clinic  for  industrial  diseases. 

(Survey,  Nov.  12,  1910,  v.  25,  p.  268- 
270.  Illustrated.) 

A  description  of  the  Milan  clinic. 

A    match    worker.      (Survey, 

Dec.  2,  1911,  v.  27,  p.  1275.  Illus- 
trated.) 

Case   of  phosphorus  necrosis. 

Bard,  C.  L.  Malignant  pustule,  and 
insanity  due  to  bisulphide  of  carbon. 
(Southern  California  practitioner, 
Los  Angeles,  1892,  v.  7:481-485.) 

Case  of  anthrax  and  discussion  of  dangers 
to  which  shepherds  are  exposed.  Three  cases 
of  insanity  from  bisu'phide  of  carbon,  one  in 
a  manufacturer  of  the  substance,  and  dis- 
cussion of  its  uses  and  eftects  on  workmen. 

Bartlett,  Elisha.  Vindication  of  the 
character  and  condition  of  the  fe- 
males employed  in  the  Lowell  mills. 
Lowell,  1841,  23  p. 

Results  of  personal  investigations  of 
health  of  operatives  in  1835  and  1841  (p. 
10-14). 


Bibliography  (American) 


371 


Baskerville,  Charles.  Air  impurities — 
dust,  fumes  and  gases.  (American 
labor  legislation  review,  June  1912, 
v.  2,  no.  2:305-311.) 

Bassoe,  Peter.  Compressed-air  dis- 
ease. (Report  of  Illinois  commis- 
sion on  occupational  diseases,  Jan. 
1911,  p.  99-150.) 

Thorough,  up-to-date  discussion,  with 
table  of  161  cases  personally  investigated, 
abstract  of  work  conducted  by  British  Ad- 
miralty, abstract  of  Henry  Japp's  article 
(q.  v.),  text  of  the  New  York  law,  summary 
of  laws  in  other  countries,  and  suggestions 
for  legislation. 

Bates,  Josephine  (White)  "Mrs.  L. 
W.  Bates."  Mercury  poisoning  in 
the  industries  of  New  York  city 
and  vicinity,  by  Mrs.  Lindon  W. 

Bates (New     York)     National 

civic  federation,  New  York  and  New 
Jersey  section  (Women's  welfare  de- 
partment), 1911,  132  p.  Illustrated. 

Results  of  an  investigation  made  by  the 
Woman's  Welfare  Department  of  the  Na- 
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criptions of  processes,  and  cases. 

Bauer,  Louis.  Pathological  effects  up- 
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exposed  to  the  action  of  a  largely 
increased  atmospheric  pressure.  (St. 
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May  10,  1870,  n.  s.  y.  7:234-245.) 

Historically  interesting  experience  with 
caisson  disease  among  workmen  on  St. 
Louis  bridge. 

Beard,  Geo.  M.  Our  home  physician. 
New  York,  1869.  "Influence  of  the 
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Historically  interesting  description,  pic- 
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Bennett,  W.  H.  Dust  as  an  exciting 
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(Medical  record,  N.  Y.,  1872,  v.  7: 
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Brief  article   on  dusty  occupations. 

Bergey,  D.  H.  Principles  of  hygiene. 
3rd  ed.  Philadelphia,  1909.  Ch.  XI. 
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On  effects  of  anilin  dyes  and  nitroben- 
zine,  influence  of  length  of  working  day  on 
health  of  laborers,  and  lighting  of  industrial 
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Betts,  W.  W.  Chalicosis  pulmonum, 
or  interstitial  pneumonia  induced  by 
stone-dust.  (Denver  medical  times, 
1899-1900,  v.  19:354-361.  Discussion, 
p.  361-366.) 

Based  on  practice  among  workers  in  a 
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effects  of  dust. 


Billings,  John  S.  Diseases  of  occupa- 
tion. (Progress  of  the  world,  Aug. 
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Good,  brief,  general  treatment  in  lecture 
before  Pratt  Institute.  Based  on  experi- 
ence in  the  Philadelphia  Hospital,  with 
special  description  of  9  cases. 

Blumer,  G.,  Young,  H.  H.  A  case  of 
anthrax  septicaemia  in  a  human  be- 
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Hopkins  hospital  bulletin,  Baltimore, 
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In  a  hair  factory  laborer,  resulting  in 
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Boston,  L.  N.  Leukocystosis  in  lead- 
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Bowen,  John  T.  Acute  infectious  pem- 
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Braymer,  O.  W.  The  sanitary  inspec- 
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Urging  importance  of  proper  legislation 
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Brigham,  Charles  H.  Influence  of  oc- 
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State  board  of  health  report,  1875, 
p.  4I-S4-) 

General  descriptions  of  effects  of  dust,  bad 
air,  noise,  eyestrain,  etc.,  and  possible  safe- 
guards. 

Brooks,  Harlow.  Caisson  disease; 
the  pathological  anatomy  and  patho- 
genesis,  with  an  experimental  study. 
(Long  Island  medical  journal,  April 
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Thorough  discussion  of  the  history,  theo- 
ries, etc.,  with  medical  history  of  cases  and 
autopsies. 

A  study  of  blood  pressure  in 

compressed-air   workers.      (Medical 
record,  N.  Y.,  1907,  v.  71:855-857.)  . 

Observations  in  75  cases  occurring  in 
employees  of  the  Belmont  Tunnel. 
Brose,  L.  D.  Amaurosis  following  the 
entrance  of  a  well  after  the  use  of 
dynamite.  (Archives  of  ophthalmol- 
ogy. N.  Y.,  1899,  v.  28:402-406.) 

Two  cases  of  prostration  and  temporary 
blindness  in  a  farmer  and  his  rescuer. 

Broughton,  M.     The  "bends."     [Cais- 


372 


American  Labor  Legislation  Review 


son  disease.]      (Medical  tribune,  N. 
Y.,  1882,  v.  4:  185-195.) 

General  discussion  based  largely  on  Dr. 
Smith's  pamphlet  (q.  v.)  with  description  of 
case  in  employee  of  Hudson  River  Tunnel. 

Burr,  C.  W.  Occupation  spasms.  (In 
A  text-book  on  nervous  diseases  by 
American  authors.  Ed.  by  Francis 
X.  Dercum,  1895,  p.  276-279.) 

Brief  discussion  of  various  occupational 
cramps. 

Burrell,  H.  L.  The  report  of  a  case  of 
anthrax.  (Transactions  of  the 
American  surgical  association,  Phila., 
1893,  v.  11:309-328.  Also  Annals  of 
surgery,  Phila.,  1893,  v.  18:605-622. 
Illustrated.  Bibliography.) 

Thorough  discussion  of  the  disease  as 
manifested  in  a  longshoreman  who  had  been 
handling  hides. 

Butler,  Elizabeth.  Women  and  the 
trades:  Pittsburgh,  1907-1908.  The 
Pittsburgh  survey.  Charities  pub- 
lication committee,  N.  Y.,  1909. 
"Health,"  p.  358-367. 

Summary  of  health  conditions  among 
women  workers  in  Pittsburgh. 

Cabot,  Richard.  The  function  of  hos- 
pitals and  clinics  in  the  prevention 
of  industrial  diseases.  (American 
labor  legislation  review,  June  1912, 
v.  2,  no.  2:  293-296.) 

Caisson  disease  and  a  safety  apparatus 
for  pneumatic  caisson  locks.  (En- 
gineering record,  N.  Y.,  1904,  v.  49: 
112-113.) 

Brief  description  of  disease,  and  descrip- 
tion and  pictures  of  a  device  for  reducing 
pressure  gradually,  invented  by  Mr.  W.  I. 
Aims,  engineer  of  the  New  York  Tunnel  Co. 

Caisson  disease,  Cases  of.  (Medical 
and  surgical  reports,  Presbyterian 
hospital,  New  York,  1896.) 

Callan,  L.  W.  Double  choked  discs 
associated"  with  compressed-air  dis- 
ease. (Archives  of  ophthalmology. 
N.  Y.,  July  1907,  v.  36:509-512.) 

Case  in  a  tunnel  worker,  and  general  dis- 
cussion of  effects  of  compressed  air  on  the 
eyes. 

Camac,  C.  N.  Bancker.  Chromic  acid 
poisoning.  (Cornell  university  med- 
ical college  bulletin,  Jan.  1905.) 

Cancer  mortality  in  the  United  States, 
by  occupations.  (In  Tenth  census, 
vital  statistics,  v.  2:  576-577-) 

Canfield,  W.  B.  Relation  of  dusty  oc- 
cupations to  pulmonary  phthisis. 
(Transactions  of  the  medical  and 
chirurgical  faculty,  Maryland.  Balti- 
more, 1889.  Report  of  the  section  of 


practice  of  medicine,  p.  106-110.  Also 
reprint.) 

Describes  case  of  a  slate  miner. 

Carpenter,  J.  T.  Mining,  considered 
with  regard  to  its  effects  upon  health 
and  life.  (Transactions,  Medical 
society  of  Pennsylvania,  Phila.,  1869, 
5.  s.  pt.  2:487-491.) 

General  discussion  of  effect  of  coal  min- 
ing on  the  health  of  miners. 

Chace,  D.  E.  Diseases  of  shop-girls 
in  notes  of  private  practice.  (Med- 
ical society  of  the  County  of  Kings, 
Brooklyn.  Proceedings,  June  1881, 
v.  6:83-89.  Discussion,  p.  89-91.) 

Record  of  150  cases,  arguing  that  lack  of 
seats  is  not  particularly  injurious. 

Chadbourne,  A.  P.  The  gastric  and 
respiratory  symptoms  caused  by  the 
dust  of  curled  hair.  (Boston  medi- 
cal and  surgical  journal,  1894,  v.  130: 

439-) 

Case  of  a  man  who  had  worked  20  years 
in  a  mattress  factory. 

Chancellor,  C.  W.  Impure  air  and  un- 
healthy occupations  as  predisposing 
causes  of  pulmonary  consumption. 
(American  public  health  association 
report,  1885,  Concord,  N.  H.,  1886,  v. 
11:67-72.) 

General  discussion  of  indoor  and  dusty 
occupations. 

Chancy,  Lucian  W.  Employment  of 
women  in  the  metal  trades.  (Report 
on  condition  of  woman  and  child 
wage-earners  in  the  United  States. 
6ist  Cong.,  2d  sess.,  Senate  doc.  645, 
v.  ii.  "Legal  provisions  against 
industrial  dangers  and  diseases,"  p. 
16-18;  "Light  and  ventilation,  dust 
and  fumes,"  etc.,  p.  22-26.) 

General  results  of  extensive,  official  in- 
vestigations. 

Chapin,  J.  B.  Insanity  following  ex- 
posure to  fumes  of  mercury.  (Amer- 
ican journal  of  insanity,  Utica,  N.  Y., 
1863-4,  v.  20:335-338.) 

General  discussion  and  description  of  a 
single  case  in  a  blacksmith  who  had  been 
engaged  for  two  years  in  "retorting  gold," 
or  driving  off  the  mercury  by  means  of  high 
temperature. 

Chenery,  Wm.  Ludlow.  Occupational 
diseases.  (Independent,  Feb.  9,  191 1, 
v.  70 :  306-309.) 

Popular  article  based  on  Dr.  Hamilton's 
report  for  the  Illinois  Commission  on  In- 
dustrial Diseases  and  Dr.  Andrews'  report 
for  the  U.  S.  Labor  Bureau  (q.  v.). 

Cheney,   Horace   B.,   La   Rue,   Omer. 

Report  of  factory  conditions  in  Con- 
necticut  as   related   to   tuberculosis. 


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(Connecticut  public  document,  spe- 
cial.    Hartford,  1908.     8  p.) 

Part  of  report  of  special  committee  to  in- 
vestigate tuberculosis,  with  special  reference 
to  the  future  enactment  of  laws  to  prevent 
its  spread. 

Church,  John  A.  Accidents  in  the 
Comstock  mines  and  their  relation 
to  deep  mining  (Transactions  of 
the  American  institute  of  mining 
engineers,  1879-1880.  v.  8:84-97. 
Abstract  in  Scientific  American, 
Nov.  i,  1879,  v.  55:272-273.) 

On  the  effects  of  excessive  heat  on  min- 
ers,— fainting,  insanity,  prostration,  and 
death. 

Clark,  E.  A.  Effects  of  increased  at- 
mospheric pressure  upon  the  human 
body  with  a  report  of  thirty-five 
cases  brought  to  city  hospital  from 
the  caisson  of  the  St.  Louis  and  Il- 
linois bridge.  (Medical  archives,  St. 
Louis,  Sept.  1870,  v.  5:  1-30.) 

Valuable  historically,  not  theoretically. 

Clark,  J.  F.  Mercurial  tremor.  (Med- 
ical record,  N.  Y.,  1893,  v.  43:  13.) 

Single  case  in  a  hatter,  with  description  of 
his  work. 

Clark,  L.  P.  Occupation  neurosis  or 
ironer's  cramp.  (Medical  record, 
N.  Y.,  1896,  v.  50:642.) 

Single  case  in   a  laundress. 

Clendening,  L.  Muscular  spasms  due 
to  heat  in  cooks  on  Pullman  diners. 
(Journal  of  American  medical  asso- 
ciati9n,  Chicago,  1910,  v.  54:  1517.) 

Brief  account  of  single  case. 

Clothing,  Men's  ready-made.  (Report 
on  condition  of  woman  and  child 
wage-earners  in  the  United  States, 
6ist  Cong.,  2d  sess.,  Senate  doc.  645. 
"Health  and  hygienic  conditions" 
(home  work),  v.  295-298;  "Ventila- 
tion of  workrooms,"  v.  2:321-322.) 

General  results  of  a  thorough  official  in- 
vestigation in  New  York  and  other  cities. 

Coleman,  J.  W.,  Jerome,  A.  T.  Some 
pathological  conditions  to  which  the 
miner  is  peculiarly  liable.  (Colora- 
do medical  journal,  Denver,  1902,  v. 
8:99-101.  Also  Medical  dial,  Minne- 
apolis, 1902,  v.  4:  183-184.) 

Effects  of  powder  smoke,  heat,  dust,  etc., 
especially  on  metal  miners. 

Cook,  J.  C.  Physical  effect  of  child 
labor  upon  the  individual.  (Illinois 
medical  journal,  Springfield,  1902-3, 
n.  s.  v.  4:509-510.) 

Brief,  general  article. 

Cooseman,  E.     The  hearing-power  of 
beetlers;   contribution   to  the   study 
of   occupation   deafness.      (Archives 
of  otology,  N.  Y.,  1899,  v.  28:  413.) 
Linen-workers  in  Belgium. 


Coplin,  W.  M.  L.,  and  others.  The  ef- 
fects of  heat  as  manifested  in  work- 
men in  sugar-refineries.  (Medical 
news,  Sept.  3,  1892,  v.  61 : 262-266.) 

Experience  with  over  200  cases  in  a  single 
refinery  in  Philadelphia  during  period  of 
eight  days. 

Corning,  J.  L.  Observations  on  the 
caisson  or  tunnel  disease,  with  notes 
on  nine  cases  which  occurred  at  the 
engineering  works  known  as  the 
Hudson  river  tunnel.  (Medical 
record,  N.  Y.,  1890,  v.  37: 513-521. 
Illustrated.  Bibliography.) 

Corporations  and  operatives.  Lowell, 
1843,  72  p. 

On  health  conditions  among  factory  oper- 
atives in  Lowell,  p.  35-40. 

Cotton  textile  industry.  (Report  on 
condition  of  woman  and  child  wage- 
earners  in  the  United  States,  6ist 
Cong.,  2d  sess.,  Senate  doc.  645.  Pre- 
pared under  the  direction  of  Chas. 
P.  Neill,  commissioner  of  labor. 
"Hygienic  conditions  of  mills,"  v. 
i :  358-367.) 

Results  of  extensive  investigations,  in  the 
North  and  the  South,  of  lighting,  venti- 
lation and  humidity,  dust  and  lint,  and  spit- 
ting on  floors. 

Cotton  and  woolen  operatives.  Dis- 
eases and  disease  tendencies  of  oc- 
cupations. (New  Jersey  bureau  of 
statistics  of  labor  and  industries, 
twenty-fifth  annual  report,  1902,  p. 
377-382.) 

General  description  and  statistics  of  sick- 
ness and  death. 

Cowgill,  J.  E.  Occupation  as  affecting 
the  death  rate.  (Medical  examiner 
and  practitioner,  N.  Y.,  July  1901, 
v.  n:339-34i.) 

General  discussion  from  actuarial  point 
of  view,  with  classification  of  occupations 
and  census  and  life  insurance  company 
statistics. 

Mortality  of  the  United 

States:  diagrams  of  the  mortality  by 
occupation.  Indianapolis,  1901. 

Crabtree,  J.  H.  The  methods  of  dust 
extraction  on  cotton-carding  en- 
gines: safeguarding  the  working- 
man's  health.  (Scientific  American, 
Dec.  30,  1911,  v.  105:592-593.  Illus- 
trated.) 

Practical. 

Crawford,  H.  M.  Medical  appliances 
for  health  and  safety  in  the  weaving 
industry.  (Cassier,  Dec.  1910,  v. 
39:  117-134.  Illustrated.) 

Mainly  on  accidents,  but  describes  and 
gives  pictures  of  safe  methods  of  thread- 
ing shuttles. 


374 


American  Labor  Legislation  Review 


Mechanical      appliances      for 

dust  extraction  in  cotton  mills.  (Gas- 
sier, Nov.  1911,  v.  40:  579-596.  Illus- 
trated.) 

With  21  illustrations  of  respirators,  dust 
extractors  and  exhaust  fans. 

Crum,  Frederick  S.  Health  and  (mor- 
tality of  the  cotton  mill  operatives 
of  Blackburn,  England.  23  p.  (Med- 
ical record,  Aug.  n,  1906,  v.  70:207- 
213.  Also  reprint.) 

Occupation  mortality  statis- 
tics of  Sheffield,  England.  1890- 
1907.  (Publications  of  the  American 
statistical  association,  Dec.  1908,  'v. 
11:309-318.) 

Two  reviews  of  English  reports.  Statis- 
tics. 

The  mortality  from  consump- 
tion in  small  cities.  (Quarterly  pub- 
lications American  statistical  asso- 
ciation, Boston,  Dec.  1907,  v.  10:448- 
479.) 

Influence  of  occupations,  with  statistics, 
p.  463-466. 

Curtis,  Josiah.  Public  hygiene  of  Mas- 
sachusetts; but  more  particularly  of 
the  cities  of  Boston  and  Lowell. 
(Transactions  of  American  medical 
association,  1849,  v.  2:487-554-  Sum- 
mary quoted  in  Documentary  ^his- 
tory  of  American  industrial  society, 

'  On  lack  of  ventilation  in  mills  and  board- 
ing houses  of  Lowell   (p.   513-519). 

Dana,  Charles  Loomis.  Text-book  of 
nervous  diseases  and  psychiatry, 
for  the  use  of  students  and  prac- 
titioners of  medicine.  7th  ed.  New 
York,  W.  Wood  and  company,  1908, 
xii,  782  p.  "Professional  neuroses, 
occupation  neuroses":  p.  609-617. 

Excellent       treatment       of       occupational 

cramps. 
Occupational      nervous      and 

mental    diseases.      (American    labor 

legislation   review,   June    1912,   v.   2, 

no.  2:  217-222.) 

Occupational  neuroses.  (Med- 

"ical  record,  Feb.  3,   1912,  v.  81,  no. 

10:451-459.     Illustrated.) 

Elaborate  clinical  study  of  100  cases,  giv- 
ing occupations  of  patients. 

Darlington,  T.  The  effect  of  the  pro- 
ducts of  high  explosives,  dynamite, 
and  nitro-glycerine,  on  the  human 
system.  (Medical  record,  N.  Y., 
1890,  v.  38:661-662.  Also  reprint.) 

Based  on  experience  as  surgeon  of  the 
Croton  Aqueduct  and  of  Arizona  mining  and 
railroad  companies. 


Darwall,  J.  Diseases  of  artisans. 
(In  Ziemssen's  Cyclopedia  of  practi- 
cal medicine,  Phila.,  1845,  v.  1:170- 
182.) 

Davis,  I.  P.  Diseases  occurring  in 
-manufacture  of  rubber  boots  and 
shoes.  (Tenth  annual  report  of  the 
board  of  health  of  New  Jersey,  1886, 
Trenton,  1887,  p.  195-200.) 

Describes  processes  of  manufacture,  con- 
ditions of  work  and  danger  of  lead  poison- 
ing, etc. 

Dennis,  L.  Hatting  as  affecting  the 
health  of  operatives.  (Report  of  the 
New  Jersey  State  board  of  health. 
1878,  p.  67-85.  Also  Report  of  the 
Connecticut  board  of  health,  1882, 
Hartford,  1883,  p.  41-59.) 

Description  of  processes  and  statistics  of 
168  cases  of  mercury  poisoning  among  1546 
hatters. 

Detmold,  W.  The  physiological  effect 
of  highly  condensed  air  on  the  hu- 
man body.  (New  York  journal  of 
medicine,  1843,  v.  i:  185-189.) 

Description  of  the  use  of  compressed  air 
in  mining  and  its  effect  on  the  miners,  based 
on  German  article.  Interesting  as  the  first 
American  article  on  caisson  disease. 

Dickey,  John  L.  "Nailers'  consump- 
tion" and  other  diseases  peculiar  to 
workers  in  iron  and  glass.  (West 
Virginia  State  board  of  health  re- 
ports, 1881-1884.  p.  149-154.) 

Describes  briefly  work  and  its  dangers, 
with  typical  case  of  "nailers'  consumption". 

Diseases  of  occupation.  (Report  of 
the  Chicago  industrial  exhibit, 
March,  1908.) 

Diseases  and  disease  tendencies  of  oc- 
cupations. (New  Jersey  bureau  of 
statistics  of  labor  and  industries, 
twenty-fourth  annual  report,  1901, 
p.  347-354-) 

General    discussion. 

Dock,  George,  Bass,  Charles  C.  Hook- 
worm disease.  St.  Louis,  1910. 
250  p. 

Describes  briefly  St.  Gothard  Tunnel  epi- 
demic, the  anemia  of  brick  workers,  miners, 


etc.  p.  22-23,  33-37.  Hookworm  disease  in 
the  United  States,  p.  37-45,  etc. 
Doehring,  C.  F.  W.  Factory  sanita- 
tion and  labor  protection.  (U.  S. 
Bureau  of  labor,  Bulletin  no.  44, 
Jan.  1903,  p.  1-131.) 

Extended  treatise  on  factory  conditions 
and  industrial  processes  injurious  to  health, 
with  lists  of  injurious  dusts  and  poisons  and 
descriptions  of  the  lead  manufacturing  and 
using  industries,  and  of  dangerous  processes 
in  the  manufacture  of  oilcloth  and  linoleum, 
linseed  oil,  tallow,  and  fertilizers.  Describes 


Bibliography  (American) 


375 


methods  of  safeguarding  workmen.  Based 
mainly  on  European  experience  and  inves- 
tigations in  a  few  factories  in  the  United 
States. 

Donaldson,  Frank.  The  influence  of 
city  life  and  occupation  in  devel- 
oping pulmonary  consumption. 
(American  public  health  association. 
Reports  and  papers,  v.  2:95-114. 
New  York,  1876.) 

Mainly  on  general  influence  of  city  life, 
but  shows  briefly  influence  of  sedentary  and 
indoor  occupations  (p.  106-7). 

Drake,  Daniel.  The  principal  diseases 
of  the  interior  valley  of  North 
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799-801. 

Draper,  Frank  W.  Arsenic  in  certain 
green  colors.  (Massachusetts  State 
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57-) 

Effects  on  workmen,  with  specific  in- 
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Dudley,  P.  The  metal  worker's  occu- 
pation and  his  health.  (Report  of 
the  board  of  health,  etc.,  of  Penn- 
sylvania, 1888-9,  fifth  annual.  Har- 
risburg,  1891,  p.  374.-3770 

Brief  general  discussion  of  the  effects  of 
dust,  especially  as  a  cause  of  consumption. 

Dust  and  its  relation  to  disease.  (Iowa 
State  board  of  health  report,  1906, 
p.  105.  Illustrated.) 

Pictures  of  lungs  of  coal  miners,  lead 
miners,  steel  grinders,  etc. 

Dusty  occupations  and  the  dust  prob- 
lem. (See  reports  of  state  factory 
inspection  departments  and  of  state 
labor  bureaus.) 

Dusty  trades  in  Massachusetts. 
(Monthly  bulletin  of  the  Massachu- 
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1910,  v.  5:  316-379.  Illustrated.) 

Mainly  illustrations,  with  brief  descrip- 
tions. List  of  processes  declared  injurious 
to  the  health  of  minors  by  State  Board  of 
Health,  July  7,  1910,  p.  378-9. 

Dutton,  Walton  Forest.  Vanadium- 
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association,  June  3,  1911,  v.  56:  1648.) 

Brief  description  of  the  poisoning  to 
which  employees  are  subject  in  establish- 
ments where  vanadium  is  produced. 

Eads,  James  B.     Report  to  the  presi- 
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and  St.  Louis  bridge  co.,  1870. 
On  compressed-air  illness  in  employees. 

Edsall,  David  L.  Diseases  due  to 
chemical  agents.  (In  Osier's  Mod- 
ern medicine,  1907,  v.  1:83-155.) 

Authoritative  treatise  on  chronic  poison- 
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causes. 


Industrial  poisoning.  (Amer- 
ican labor  legislation  review,  June 
1912,  v.  2,  no.  2:231-234.) 

Some  of  the  relations  of  occu- 
pations to  medicine.  (Journal  of 
American  medical  association,  Dec. 

4,  1909,    v.    53:  1873-81.      Wisconsin 
medical  journal,  Jan.  1910,  v.  8:425- 
447-) 

Good  general  discussion  of  the  disease 
tendencies  of  occupations. 

Elliott,  E.  Leavenworth.  Factory 
lighting:  topical  criticism  of  exist- 
ing laws.  (American  labor  legisla- 
tion review,  June  1911,  v.  i,  no.  2: 

IIO-II2.) 

Brief  criticism  of  existing  laws,  with  sug- 
gestions for  improvements. 

Elliott,  W.  C.  Measures  to  protect 
workers  in  factories  and  elsewhere 
from  noxious  dust  and  fumes. 
(Transactions  of  the  Medical  society 
of  Wisconsin,  Madison,  1896,  v.  30: 
360-362.) 

Brief  plea  for  the  protection  of  the  metal 
polisher. 

Emerson,  Nathaniel  B.,  Tracy,  Roger 

5.  On  the  manufacture  of  cigars  in 
tenement  houses.     (New  York  city 
board   of  health   report,   1874-75,   p. 
649-656.) 

Results  of  personal  investigation  of  air, 
light,  ventilation,  etc.,  with  special  reference 
to  the  effects  on  the  health  of  workers  and 
their  families. 

Endemann,  H.  The  operations  of 
cleansing  hair  and  manufacturing 
felt.  (New  <York  city  board  of 
health  report,  1872,  p.  305.) 

Brief  account  of  dust  conditions,  advo- 
cating use  of  respirators  by  working  people. 

Erdman,  Seward.  Aeropathy  or  com- 
pressed-air illness  among  tunnel 
workers.  (Journal  of  American 
medical  association,  Nov.  16,  1907, 
v.  49:  1665-1670.) 

General  review  of  history,  theories,  etc. 

Exline,  J.  W.  The  sanitation  of  mines. 
(Transactions  of  the  Colorado  med- 
ical society,  Denver,  1896,  p.  235-242. 
Also  Medical  age,  Detroit,  1897,  v. 
15:99-102.) 

General  discussion,  with  special  reference 
to  the  prevention  of  disease  in  Colorado 
mines. 

Fantus,  B.  The  diagnosis  and  treat- 
ment of  plumbism.  (Illinois  medical 
journal,  Springfield,  1910,  v.  17:616- 
621.) 

Mainly  technical,  but  names  trades  which 
are  most  likely  to  produce  plumbism,  and 
gives  special  attention  to  symptoms. 


376 


American  Labor  Legislation  Review 


Farrar,  J.  N.  Importance  of  direct 
sunlight  in  the  workroom;  useful- 
ness in  art,  and  its  bearing  upon 
the  general  health.  (In  American 
dental  association.  Transactions, 
1877.  Elgin,  1878,  v.  17:77-85.) 

General  argument  applied  mainly  to  health 
of  dentists,  but  using  as  illustrations  Wal- 
tham  and  Elgin  watch  factories  (p.  83-84). 

Favill,  Henry  Baird.  Importance  of 
industrial  hygiene.  (American  asso- 
ciation for  labor  legislation,  1910. 
Publication  no.  10:9-11.) 

Brief  remarks  as  presiding  officer  at  First 
National  Conference  on  Industrial  Diseases. 

........  Industrial    hygiene     and     the 

police  power.  A  reprint  of  a  paper, 
prepared  for  the  American  associa- 
tion for  labor  legislation,  on  the 
Legitimate  exercise  of  the  police 
power  for  the  protection  of  health. 
(From  the  Thirteenth  biennial  re- 
port of  the  Wisconsin  bureau  of 
labor  and  industrial  statistics.  Mad- 
ison, Wisconsin,  1908,  p.  479-486. 
Also  in  Transactions  of  the  Sixth 
international  congress  on  tubercu- 
losis, Washington,  1908.) 

Shows  the  necessity  for  extensive  regula- 
tion of  unhealthful  trades,  based  on  scien- 
tific research. 

........  The  toxin   of  fatigue.      (Pro- 

ceedings, Thirty-seventh  annual  ses- 
sion of  the  National  conference  of 
charities  and  corrections,  p.  405-414-) 

On  iatigue  as  a  factor  in  standardizing 
hours  of  labor. 

Female  health,  Special  effects  of  cer- 
tain forms  of  employment  upon. 
(Sixth  annual  report  of  the  Massa- 
chusetts bureau  of  statistics  of  labor, 
1875,  part  II,  p.  67-112.) 

Describes  especially  the  manufacture  ot 
textile  fabrics,  typesetting,  telegraphy,  and 
sewing  machine  labor. 

Fisher,  Irving.  Industrial  hygiene  as 
a  factor  in  human  conservation. 
(Academy  of  political  science,  New 
York,  v.  2,  no.  2:  1-9.) 

Relates  primarily  to  women  and  children. 

Fitch,  John  A.  The  steel  workers. 
The  Pittsburgh  survey.  Charities 


publication  committee,  N.  Y. 
"Health  and  accidents  in  steel  mak- 

Effects  of  heat,  dust,  noise,  nervous  strain, 
and  long  hours. 

Foley,  J.  L.    The  influence  of  occupa- 

tion  in   skin   diseases.      (Journal   of 

cutaneous    and    genito-urinary    dis- 

eases, N.  Y.,  1889,  v.  7:170-178.) 

General    discussion    and    classification    ot 


occupational  skin  diseases  by  a  London 
(Eng.)  physician. 

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Practically  same  as  article  in  American 
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v.). 

Freeman,  J.  Addison.  Mercurial  dis- 
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1860,  p.  61-64.) 

One  hundred  cases  in  Orange  and  cases 
in  other  New  Jersey  cities. 

French,  John  Marshall.  Occupation 
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examiner  and  practitioner,  N.  Y., 
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Statistical  study  based  on  Massachusetts 
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Occupation      and      longevity. 

(Annals  of  hygiene,  Phila.,  1896,  v. 
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Brief,  general  discussion. 

Freudenthal,  Wolff.  In  what  relation 
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.  .1 (Ninth  annual  report  of 

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378 


American  Labor  Legislation  Review 


II,  p.  68-91.     Albany,  1910.) 

Includes  special  investigation  of  the  calico 
print  industry,  bakeries  in  Manhattan  bor- 
ough, and  potteries. 

(Eleventh  annual  report 
of  the  commissioner  of  labor  for  the 
year  ended  Sept.  30,  1911.  Appendix 
II,  p.  69-133.  Albany,  1912.) 

Includes  special  investigation  of  ventila- 
tion of  a  department  store  and  of  the  cloak 
and  suit  industry  in  New  York  City. 

,  ......  (Tenth  annual  report  of 

the  commissioner  of  labor  for  the 
year  ended  Sept.  30,  1910.  Appendix 
II,  p.  62-111.  Albany,  1911.) 

Includes  special  investigation  of  the  phos- 
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industry. 

These  reports  contain  valuable  data  con- 
cerning the  sanitation  and  ventilation  of  fac- 
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Ventilation  of  industrial  es- 
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Medical  inspection  of  indus- 
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Extended  discussion  of  Lowell  factory 
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green.  (New  York  journal  of  med- 
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Death  of  a  f9urtecn  year  old  boy  who  had 
been  wonting  in  an  establishment  for  the 
manufacture  of  paper  hangings,  with  account 
of  proceedings  of  the  coroner's  jury. 

Guilford,  Paul.  Will  certain  occupa- 
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Results  of  examination  of  22  locomotive 
engineers  over  SO  years  of  age. 

Gulick,  Luther.    The  effects  of  mental 


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Hackley,  Chas.  E.,  Walter,  Emma  E. 
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Brief    general    discussion. 

Haines,  Walter  S.,  Karasek,  Mathew, 
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Based  on  original  investigations  in  Illinois 
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Hall,  H.  N.  Preventive  medicine 
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Based  on  experience  as  physician  of  the 
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Hall,  J.  N.  Trainman's  back.  (Na- 
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Report    on    investigations    of 

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Lead  poisoning  in  Illinois. 

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General  discussion,  without  statistics, 
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Health  and  duration  of  trade  life  of 
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Health  and  its  relation  to  occupation. 

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85.) 

Health  in  industries.  (Montana  bu- 
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Individual  reports  of  quartz  miners,  smelt- 
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health  at  beginning  work,  health  "now",  and 
sanitary  conditions  of  their  work.  Analysis 
of  these  reports  by  occupations. 

Health  in  industry.  (Wisconsin  bu- 
reau of  statistics,  third  biennial  re- 
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"Trade  statistics,  showing  peculiar- 
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Compiled  from  reports  made  by  workmen 
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Health  in  various  industries  and  causes 
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Tables,  showing  age  at  which  the  work- 
men begin  to  decline,  age  at  which  they  be- 
come incapacitated  for  active  work,  and  dis- 
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cotton,  woolen,  hat,  and  other  industries. 

Health  of  employees  in  various  in- 
dustries. (California  bureau  of  la- 
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Also  in  Proceedings  of  the  first  an- 


382 


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Problems   of    social   statistics 

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Disease  treated  merely  as  accounting  for 
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Based  on  diagram  prepared  by  Miss 
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Hughes,  C.  H.  Railway  brain  strain 
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Urging  sanitary  regulations  to  prevent 
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Karasek,    Stella,    Karasek,    Matthew. 

Preliminary  report  on  the  injurious 
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Authoritative  article  by  physician  in 
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Compressed-air  illness.  (Amer- 
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1912,  v.  2,  no.  2:  192-205.) 

Kelley,  Florence.  The  sex  problems 
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journal  of  public  hygiene,  Boston. 
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Brief  plea  for  legal  regulation  of  the 
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Kimball,  D.  D.  Ventilation  and  pub- 
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General  article,  only  incidentally  relating 
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King,  William  A.    Mortality  statistics 
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Ten  tables  with  discussion. 

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Based  on  experience  as  welfare  manager 
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General  discussion  and  history  of  17  cases 
that  came  under  his  observation  as  surgeon 
during  the  sinking  of  two  caissons  for  a 
coal  mining  company. 

Knapp,  P.  C.  A  case  of  professional 
neurosis  of  co-ordination  of  unus- 
ual origin.  (Journal  of  nervous  and 
mental  diseases,  N.  Y.,  1887,  n.  s., 
v.  12:41-45.  Also  reprint.) 

In  a  carpet  maker,  with  general  discussion 
of  occupation  neuroses. 

Kober,  George  Martin.  Industrial 
hygiene.  A  report  of  the  committee 
on  social  betterment  of  the  Presi- 
dent's homes  commission,  1908. 
Washington,  D.  C.,  iv,  8-175  p. 
(Also  in  reports  of  the  President's 
homes  commission,  6oth  Cong.,  2d 
sess.,  Senate  doc.  644,  p.  25-107. 
Washington,  1909.) 

Comprehensive  general  treatise  on  con- 
ditions in  1907  in  a  considerable  number 
of  trades,  with  discussion  of  measures,  legal 
and  otherwise,  which  would  improve  con- 
ditions. 

Industrial     hygiene.       (U.     S. 

Bureau    of    labor,    Bulletin    no.    75, 
March  1908,  p.  472-591.) 


Bibliography  (American) 


385 


Similar  to  the  above,  with  text  of  English 
laws  for  the  regulation  of  dangerous  and 
unhealthful  industries. 

Korshet,  M.  Diseases  of  occupation. 
(New  York  medical  journal,  1911,  v. 
93:ii34-n37.) 

On  effects  of  chronic  fatigue,  occupation 
dusts,  industrial  poisons,  compressed  air, 
woman's  work,  child  labor,  etc. 

Lane,  Francis,  Ellis,  John  B.  Miner's 
nystagmus.  (Report  of  Illinois  com- 
mission on  occupational  diseases, 
Jan.  1911,  p.  155.) 

Brief  report  on  investigations  in  Illinois. 

Laundries,  Employment  of  women  in. 
(Report  on  condition  of  woman  and 
child  wage-earners  in  the  United' 
States,  6ist  Cong.,  2d  sess.,  Senate 
doc.  645,  v.  12.  Prepared  under  the 
direction  of  Chas.  P.  Neill,  commis- 
sioner of  labor.  Effect  of  laundry 
work  upon  health,  p.  25-118.) 

Results  of  thorough  investigation  of  this 
industry  in  Chicago,  New  York,  Brooklyn, 
Philadelphia,  and  Rockford,  111. 

Law,  James.  Report  on  the  malig- 
nant anthrax  in  herds,  and  malig- 
nant pustule  in  men,  in  Livingston 
county,  N.  Y.,  in  Sept.  1875.  (Amer- 
ican public  health  association.  Re- 
ports and  papers,  v.  2:465-467.) 

Describes  three  cases  of  anthrax  in  the 
manager  of  a  farm  and  two  German  work- 
men. 

Laws,  G.  C.  The  effects  of  nitro-gly- 
cerine  upon  those  who  manufacture 
it.  (Journal  of  American  medical 
association,  Chicago,  1898,  v.  31:  793- 
794-) 

Based  on  experience  among  employees  of 
a  large  nitro-glycerine  factory  in  New  Jersey. 

Laws  relating  to  occupational  dis- 
eases and  industrial  hygiene.  (Twen- 
ty-second annual  report  of  the  U. 
S.  commissioner  of  labor,  1903. 
U.  S.  Bureau  of  labor,  Bulletins  no. 
85,  91  and  97.) 

Laws  enacted  during  1911  re- 
quiring the  report  of  occupational 
diseases.  (U.  S.  Bureau  of  labor, 
Bulletin  no.  95.  July  1911,  p.  283- 
288.) 

Act  providing  for  a  tax  on 

white  phosphorus  matches  and  for 
prohibiting  their  import  or  export. 
[Approved  April  9,  1912.]  (U.  S.  Bu- 
reau of  labor,  Bulletin  no.  100,  May 
1912,  p.  760-762.) 

Comfort,  health  and  safety 

in  factories.  Comparative  analysis 
of  existing  laws.  (American  labor 


legislation  review,  June   1911,  v.   I, 
no.  2:  i-ioi.) 
Review  of  labor  legislation  of 

1911.  (American    labor    legislation 
review,  Oct.  1911.  v.  I,  no.  3.) 

Lea,  M.  C.  On  the  poisonous  effects 
resulting  from  the  employment  of 
arsenical  preparations  in  the  arts. 
(American  journal  of  medical  sci- 
ences, Phila.,  1860,  n.  s.  v.  40:  110- 
112.) 

Brief,  general  discussion  of  effects  on  em- 
ployees and  consumers,  urging  legislation  to 
stop  its  use. 

Lead.  Hearings  before  the  Committee 
on  interstate  and  foreign  commerce 
of  the  House  of  representatives,  on 
H.  R.  21901.  Manufacture,  sale,  etc., 
of  adulterated  or  mislabeled  white 
lead  and  mixed  paint.  May  31,  1910. 
52  p. 

Contains  testimony  on  lead  poisoning.  See 
index. 

Leather  industry,  Health  conditions  of 
the.  Diseases  and  disease  tenden- 
cies of  occupations.  (New  Jersey 
bureau  of  statistics  of  labor  and  in- 
dustries, twenty-ninth  annual!  re- 
port, Camden,  1906,  p.  209-234.) 

General  discussion  and  statistics  of  health 
and  accident  conditions. 

Leupp,  Constance  D.  Phossy  jaw. 
(Twentieth  century  magazine,  Mar. 

1912,  v.  5:28-35.) 

Popular  article  based  on  Dr.  Andrews'  in- 
vestigations (q.  v.). 

Levis,  R.  J.  Phosphor-necrosis.  (Med- 
ical and  surgical  reporter,  Phila., 
1879,  y.  41:450-451.) 

Brief  general  description,  based  on  ob- 
servation of  many  cases  in  Philadelphia  and 
Wilmington  match  factories,  and  description 
of  a  single  case  in  a  match  factory  worker. 

Lewis,  G.  L.  The  effects  of  com- 
pressed air  upon  the  human  system, 
as  evinced  in  the  sinking  of  bridge 
piers  during  the  construction  of  the 
Atchison  bridge  over  the  Missouri 
river.  (Transactions  of  the  medical 
society  of  Kansas,  1860-77,  Law- 
rence, 1884,  v.  1:279-291.) 

History  of  use  of  compressed  air,  de- 
scription of  a  caisson,  and  observations  on 
some  fifty  cases  which  he  treated  as  surgeon 
of  the  American  Bridge  Company. 

Lewis,  Morris  J.  The  neural  disor- 
ders of  writers  and  artisans.  (In 
Pepper's  American  system  of  prac- 
tical medicine,  Philadelphia,  1886,  v. 
5 :  504-543.) 

Extended  discussion  of  occupational 
cramps. 


American  Labor  Legislation  Review 


Library  of  congress.  Division  of  bibli- 
ography. Select  list  of  references 
on  occupational  injuries  and  dis- 
eases. Aug.  25,  1910.  Typewritten 
10  p. 

Lincoln,  David  Francis.  School  and 
industrial  hygiene.  Philadelphia. 
Blakiston,  1880.  American  health 
primers.  144  p. 

Part  II  (p.  107-144)  is  an  elementary 
treatise  on  industrial  hygiene. 

Linenthal,  Harry.  Sanitation  of  cloth- 
ing factories  and  tenement-house 
workrooms.  (In  Tuberculosis  in 
Massachusetts,  ed.  by  Edwin  A. 
Locke,  p.  28-36.  Illustrated.) 

Brief  statement  of  conditions  in  men's 
clothing  industry  in  Boston. 

The  prevention  of  occupation- 
al diseases.  (Boston  medical  and 
surgical  journal,  May  23,  1912,  v. 
166:779-783.  Also  reprint.) 

Based  on  experience  as  state  inspector  of 
health  in  Massachusetts. 

Lloyd,  James  Hendrie.  The  diseases 
of  occupations.  (In  Stedman,  Twen- 
tieth century  practice.  New  York, 
1895.  v.  3:309-496.) 

TKbrough  treatise  covering  all  the  common 
occupational  diseases,  with  brief  review  of 
the  literature  and  of  the  legal  restraints  on 
the  employment  of  women  and  children  in 
the  United  States. 

Occupation  neuroses  and  poi- 
sonings in  the  arts  and  by  foods. 
(In  Modern  treatment,  ed.  by  H.  A. 
Hare,  1910-1911,  v.  2:583-619.) 

Including  miner's  nystagmus,  lead,  ar- 
senic, phosphorus  and  mercury  poisoning, 
etc. 

Loeb,  H.  W.  Railroad  dust  in  rail- 
roaders' noses.  (National  associa- 
tion of  railway  surgeons.  Official 
report  of  the  fifth  annual  meeting, 
Chicago,  1892,  p.  208-211.) 

Diseases  resulting  from  such  dust. 

Loomis,  H.  P.  Miners'  phthises. 
(Proceedings  of  the  New  York 
pathological  society,  1891.  N.  Y., 
1892,  p.  52.) 

Brief  description  of  a  lung,  said  to  be  an 
example  of  "miner's  phthisis." 

Lovejoy,  O.  R.  Age  problems  in  in- 
dustrial hygiene.  (American  jour- 
nal of  public  hygiene,  Boston,  June 
1910,  v.  20:233-238.) 

An  argument  for  the  legal  regulation  of 
child  labor. 

Maclay,  J.  W.  Prize  essay  on  the  re- 
lations of  the  different  professions 
and  vocations  to  longevity.  N.  Y., 
1873-  58  p. 


Macleod,  J.  J.  R.  Cause,  treatment 
arid  prevention  of  the  "bends"  as 
observed  in  caisson  sickness.  (As- 
sociation of  engineering  societies 
journal,  Boston,  1907,  v.  39:283-302.) 

An  excellent,  comprehensive  article  by 
a  former  associate  of  Leonard  Hill  in  ex- 
perimental work. 

M'Cready,  B.  W.  On  the  influence  of 
trades,  professions  and  occupations 
in  the  United  States  in  the  produc- 
tion of  disease.  (In  the  Medical 
society  of  New  York.  Transac- 
tions, 1836-1837.  Albany,  1837.  v. 
3:91-150.) 

Historically  interesting  as  the  first  gen- 
eral treatment  of  the  subject  in  American 
literature.  Describes  the  unhealthful  con- 
ditions of  work  of  seamen,  women  and  chil- 
dren in  textile  factories,  tailors,  shoemakers, 
sewing  women,  printers,  butchers,  smiths, 
gold  beaters,  carpenters,  painters,  profes- 
sional men,  etc.  "Prize  Dissertation  for 
1837." 

McConnell,  J.  W.  Case  of  pronator 
spasm  in  a  compositor.  (Philadel- 
phia polyclinic,  April  28,  1894,  v.  3: 
161-162.) 

Description  of  a   single  case. 

An  uncommon  case  of  occu- 
pation neurosis.  (Philadelphia  poly- 
clinic,  March  20,  1897,  v.  6:  123-124.) 

In    a   brick   sorter. 

McDowell,  W.  J.  Oyster  shucker's 
corneitis.  (Virginia  medical  month- 
ly, 1879,  v.  5  :  883-885.) 

Based  on  experience  with  between  forty 
and  fifty  cases  of  this  eye  disease  in  oyster 
shuckers. 

McKay,  George  A.  The  effect  upon 
the  health,  morals,  and  mentality  of 
working  people  employed  in  over- 
crowded workshops.  (Fifth  annual 
report  of  the  New  York  state  fac- 
tory inspector,  Albany,  1891,  p.  77- 
90.) 

General  discussion  of  results  of  over- 
crowding. 

McNeill,  George  E.  Dangerous  trades 
and  occupations.  (Insurance  press, 
N.  Y.,  July  26,  1905,  p.  2-4.) 

Industrial  diseases  from  the  insurance 
point  of  view  (9  columns). 

Manning,  Caroline.  Violations  of 
health  laws  in  women-employing  in- 
dustries. (In  Labor  laws  and  their 
enforcement,  with  special  reference 
to  Massachusetts.  Susan  M.  Kings- 
bury,  ed.  Boston,  1911.  p.  I52-I55-) 

Brief  account  of  personal  investigations 
in  29  factories,  stores  and  restaurants. 

Manning,  Wm.  J.  Health  of  em- 
ployees in  the  government  printing 


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office,  Washington.  (U.  S.  Bureau 
of  labor,  Bulletin  no.  75:497-508.) 

Mainly  description  of  methods  in  use  for 
the  prevention  of  lead  poisoning. 

Marriott,  W.  McKim.     The  air  they 

breathe  in  New  York  factories. 
(Charities  and  the  commons,  Nov. 
10,  1906,  v.  17:274-276.) 

Results  of  an  examination  of  air  in  a 
number  of  factories  in  New  York  City. 
Table  and  chart. 

Marshall,  S.  A.  [Caisson  disease.] 
(Long  Island  medical  journal,  April, 
1907,  v.  i:  183-184.) 

Based   on  experience   among  workmen   in,, 
the    Pennsylvania    railroad    tunnel.      Discus- 
sion of  Dr.  Gallivan's  paper  (q.  v.). 

Martin,  John.  Factory  legislation  and 
tuberculosis.  (Transactions  of  the 
Sixth  international  congress  on  tu- 
berculosis. Washington,  1908.  v.  3: 

179-183.) 

Brief  discussion  of  dusty  occupations  and 
legislation  providing  for  ventilation. 

Massachusetts.  First  annual  report  of 
the  work  of  the  state  inspectors  of 
health.  (In  Thirty-ninth  annual  re- 
port of  the  State  board  of  health  of 
Massachusetts.  Boston,  1907.  p. 
459-485.) 

Second  annual  report.  (In 

Fortieth  annual  report  of  the  State 
board  of  health  of  Massachusetts. 
Boston,  1908.  p.  653-750.  Illus- 
trated.) 

Third  annual  report.  (In  For- 
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board  of  health  of  Massachusetts. 
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Fourth  annual  report.  (In 

Forty-second  annual  report  of  the 
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Fifth  annual  report.  (In  For- 
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board  of  health  of  Massachusetts. 
Boston,  1911.) 

These  annual  reports  furnish  a  valuable 
source  of  information  on  factory  and  work- 
shop conditions  and  methods  by  which  they 
may  be  improved,  and  contain  discussions 
of  specific  occupational  diseases  and  danger- 
ous processes.  But  they  also  cover  tene- 
ment and  schoolhouse  hygiene,  etc. 

Massachusetts  House  docu- 
ments no.  50,  March,  1845;  no.  153, 
1850.  (Reprinted  in  Documentary 
history  of  American  industrial  so- 
ciety, Cleveland,  1910,  v.  8:133-186.) 

Testimony  on  effect  of  long  hours  of 
labor  on  health  of  factory  operatives. 

Mayo,  Earl.     Work  that  kills.     (Out- 


look, Sept.  23,  1911,  v.  99:  203-213. 
Illustrated.) 

Popular  general  article  covering  subject 
of  industrial  diseases. 

Mears,  J.  Ewing.  Phosphorus  necro- 
sis of  the  jaws.  (Philadelphia  med- 
ical times,  Jan.  9,  1886,  v.  16:264- 
275.  Illustrated.  Also  Transactions 
American  surgical  association,  1885, 
v.  3:357-385.  Also  reprint.) 

Elaborate  paper  based  on  European 
sources  and  on  examinations  of  a  large  num- 
ber of  employees  in  match  factories,  and  the 
treatment  of  sixteen  cases  in  this  country. 

Meigs,  Arthur  V.  Caisson  disease. 
A  clinical  lecture.  (Philadelphia 
medical  news,  Nov.  28,  1885,  v.  47: 
589-592.) 

Based  mainly  on  Jaminet's,  Smith's, 
Bauer's,  and  Clark's  articles,  and  on  Wood- 
ward's History  of  the  St.  Louis  Bridge 
(q.  v.). 

Memorial    on    occupational    diseases. 

Prepared  by  a  committee  of  ex- 
perts appointed  by  the  American 
association  for  labor  legislation, 
and  presented  to  the  President  of 
the  United  States.  (American  labor 
legislation  review,  Jan.  1911,  v.  i, 
no.  1:125-143.  Also  reprint.) 

This  memorial  lays  the  groundwork  for 
a  federal  investigation. 

Mercury.  Physiological  effects  of  the 
mercury  arc:  its  influence  upon  the 
eye.  (Scientific  American  supple- 
ment, Oct.  7,  1911,  v.  72:235-236.) 

Brief  general  article  on  artificial  light, 
with  only  incidental  reference  to  working 
people. 

Merk,  Fred.  Industrial  diseases.  (Or- 
ation, University  of  Wisconsin,  n.  p. 
1911.  5  P-) 

Mettler,  L.  H.  Occupation  neuroses. 
(Clinical  review,  Chicago,  1904-1905, 
v.  21:43-60.) 

General  discussion  of  various  types  of 
nerve  disorders  due  to  occupation. 

Middleton,  P.  Harvey.  White  phos- 
phorus horror.  (Technical  world 
magazine,  April  1911,  v.  15:  146-155. 
Illustrated.) 

Popular  article. 

Miles,  Henry  A.  Lowell  as  it  was  and 
as  it  is.  Lowell,  1845.  234  p.  "Pro- 
visions for  the  comfort  and  health 
of  the  operatives",  p.  116-127. 

Argues  that  the  factory  population,  espe- 
cially the  women,  were  in  good  health. 

Miller,  James  A.  Pulmonary  tuber- 
culosis among  printers.  (Transac- 
tions of  the  Sixth  international  con- 
gress on  tuberculosis.  Washington, 
1908.  v.  3:209-216.) 


388 


American  Labor  Legislation  Review 


Results  of  thorough  physical  examinations 
of  200  printers  in  New  York  City,  with  des- 
cription of  working  conditions. 

Mills,  Charles  Karsner.  Occupation 
neuroses;  affections  of  the  neuro- 
muscular  apparatus  due  to  special 
occupations.  (In  Loomis  and 
Thompson,  A  system  of  practical 
medicine,  v.  4:  597-610.  New  York, 
1898.) 

Good  general  discussion  of  fatigue  neu- 
roses, occupation  cramps  and  other  forms  of 
nervous  disease  due  to  occupation,  with 
methods  of  treatment. 

Mental  overwork  and  prema- 
ture disease  among  public  and  pro- 
fessional men.  (Smithsonian  mis- 
cellaneous collections,  no.  594. 
Washington,  1885,  34  p.) 

Moss,  R.  E.  Occupations.  (Medical 
examiner  and  practitioner,  N.  Y., 
1902,  v.  12:  710-712.) 

Occupations  as  affecting  insurance  risks, 
giving  diseases  characteristic  of  a  large  num- 
ber of  different  occupations. 

Moyer,  H.  N.  A  rare  occupation 
neurosis  (shoe  salesman's  disease). 
(Medical  news,  Philadelphia,  1893,  v. 
62:  188-189.) 

Brief  general  discussion  and  description  of 
a  single  case. 

Municipal  ordinances,  rules,  and  regu- 
lations pertaining  to  public  hygiene 
adopted  from  January  i,  1910,  to 
June  30,  1911,  by  cities  of  the  United 
States  having  a  population  of  over 
25,000  in  1910.  Prepared  by  direc- 
tion of  the  surgeon  general.  U.  S. 
Public  health  and  marine-hospital 
service.  Washington,'  Gov't.  print, 
off.,  1912,  244  p. 

Murray,  F.  W.  Anthrax  maligna. 
(New  York  medical  journal,  1889, 
v.  49:  144-147.  Also  reprint.) 

General  discussion,  with  a  description 
of  four  cases,  a  porter  in  a  restaurant,  a 
longshoreman,  a  clerk,  and  a  groom. 

Myers,  R.  M.  Cramps  as  affecting  sto- 
kers. (Virginia  medical  semi-month- 
ly, Richmond,  1897-8,  v.  2:552-553.) 

Observations  as  ship  surgeon  on  one  of 
the  trans-Atlantic  lines. 

Nearing,  Scott.  Social  adjustment. 
New  York,  Macmillan  co.,  1911,  377 
p.  Ch.  xi.  "Dangerous  trades",  p. 

2II-22I. 

Brief,  popular  discussion. 

Neer,  C.  S.  The  value  of  examination 
of  the  blood  in  the  diagnosis  of 
chronic  lead  poisoning.  (Interstate 
medical  journal,  St.  Louis,  1907,  v. 
14:838-843.) 


General   discussion  and   account   of  three 
cases,  all  occupational  in  origin. 

Nevin,  John.  Occupational  diseases. 
(Medical  examiner  and  general  prac- 
titioner, N.  Y.,  Aug.  1908,  v.  19:254- 
256.) 

As  affecting  insurance  risks. 

Newton,  W.  K.  An  inquiry  into  the 
causes  of  disease  among  workers  in 
silk,  flax,  and  jute.  (Tenth  annual 
report  of  the  board  of  health  of 
New  Jersey,  1886,  Trenton,  1887,  p. 
188-194.) 

Describes  processes  and  sanitary  condi- 
tions in  workrooms. 

Nicholl,  R.  H.,  Flinn,  T.  E.,  Hay- 
hurst,  E.  R.  Effects  of  turpentine 
upon  the  health  of  workmen.  (Re- 
port of  Illinois  commission  on  oc- 
cupational diseas/es,  Jan.  1911,  p. 
84-88.) 

Results  of  investigations  of  62  men  in 
Chicago. 

Nichols,  Arthur  H.  The  effects  on 
health  of  the  use  of  sewing  machines 
moved  by  foot-power.  (Massachu- 
setts State  board  of  health  report, 
1872,  p.  180-221.) 

Based  on  personal  investigations  and  re- 
turns from  many  correspondents. 

Norton,  H.  G.  Dangers  of  the  potters' 
trade  from  the  life  insurance  stand- 
point. (Medical  examiner  and  prac- 
titioner, New  York,  1906,  v.  16:242- 
246.) 

Description  of  various  branches  of  the 
work  and  their  special  dangers,  with  particu- 
lar reference  to  the  Trenton,  N.  J.,  potteries: 

Obenauer,  Marie  L.  Working  hours, 
earnings  and  duration  of  employ- 
ment of  women  workers  in  selected 
industries  of  Maryland  and  of  Cali- 
fornia. (U.  S.  Bureau  of  labor,  Bul- 
letin 96.)  Sanitary  conditions  in 
canneries,  p.  359-362,  368,  401-403. 

Occupation  mortality  statistics.  Cen- 
sus of  1890.  Deaths  of  males  in  cer- 
tain occupations,  in  certain  cities, 
and  from  certain  causes,  v.  VII,  Re- 
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18,  p.  1130.  Washington,  1896. 

..Census  of  1900.  Occupations 

in  relation  to  deaths.  Report  on 
vital  statistics,  Part  I,  sec.  xiii,  p. 
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i. .  Bureau  of  the  census.  Annual 

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390 


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Precautions  against,  types,  and  treat- 
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Perry,  S.  H.  Brass-workers'  disease. 
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Peterson,  F.  Three  cases  of  acute 
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...Hearings  .  .  .  January  10, 

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Hearings  on  bills  relating  to 

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These  hearings,  together  with  Dr.  An- 
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In  a  brass  molder  in  Chicago. 

Polishing  and  buffing.  (Fourteenth 
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Pottery  industry,  Health  conditions  in 
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........  Lead  poisoning  in  New  York 

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Price,  George  M.  Hygiene  of  occupa- 
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Comprehensive    discussion    of    the    entire 

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Brief  discussion  based  on  experience  as 
special  investigator  for  Joint  Board  of  San- 
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Discussion  of  occupations  which  may  lead 
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Sharpies,  C.  W.  A  contribution  to 
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Describes  character  of  work,  danger  from 
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tion. (U.  S.  Bureau  of  labor,  Bulle- 
tin no.  86,  Jan.  1910,  p.  147-169) 

Sommerfeld,  Th.,  Fischer,  R.  List  of 
industrial  poisons  and  other  sub- 
stances injurious  to  health  found  in 
industrial  processes.  Prepared  un- 
der the  auspices  of  the  International 
association  for  labor  legislation. 
(U.  S.  Bureau  of  labor,  Bulletin 
no.  TOO,  May  1912,  p.  733-759-) 

This  is  a  revision  of  the  list  in  Bulletin 
86,  with  an  outline  of  the  work  along  this 
line  of  the  International  Association  for 
Labor  Legislation  and  an  outline  by  Dr. 
Fiscker  of  measures  for  the  protection  of 
workers  against  danger  of  poison. 

Soper,  George  A.  The  air  and  venti- 
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and  sons,  1009,  244  p.  Health  of 
employees  in  European  subways,  p. 
77,  98.  "Health  of  New  York  sub- 
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Technology  quarterly,  Boston,  1907, 
v.  20:  218-245.) 

Results  of  original  investigations  into  the 
effects  of  metallic  dust  on  health  of  em- 
ployees. Practically  identical  with  report 
made  in  1907  to  the  Board  of  Rapid  Transit 
Commissioners  of  the  City  of  New  York. 

Special  regulations  for  dangerous  and 
unhealthy  industries  enforced  by  the 
factory  inspectors  in  England. 
(New  ^  York  State  bureau  of  labor 
statistics,  twenty-fourth  annual  re- 
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Text  of  English  laws. 

Spratling,  W.  P.  Report  of  fifty- 
seven  cases  of  insanity  occurring  in 


six  years  among  silk-mill  employees 
in  a  manufacturing  city  in  New  Jer- 
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1894,  v.  59:614-616.) 

Gives  cause  as  "prolonged  and  excessive 
overtax  of  mind  and  body"  in  the  course 
of  their  occupation.  Tables. 

Stainsby,  William.  Diseases  and  dis- 
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glass  industry  and  the  hatting  in- 
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report  of  the  Bureau  of  statistics 
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(See  Glass  industry  and  Hatting  industry.) 

Standen,  Wm.  T.  The  effect  of  occu- 
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Gives  classification  of  occupations,  with 
number  of  insurance  companies  which  re- 
ject persons  in  each,  number  which  discrim- 
inate against  the  specified  occupations,  and 
number  which  accept  persons  engaged  in 
them  without  restriction. 

Starr,  M.  Allen.  Industrial  diseases 
due  to  the  use  of  metallic  poisons 
and  the  measures  needed  for  their 
prevention.  (Medical  record,  N.  Y., 
Feb.  3,  1912,  v.  81:205-207.) 

Discusses  briefly  lead,  arsenic,  mercury 
and  phosphorus. 

Stevens,  George  A.  The  health  of 
printers:  a  study  in  industrial  hy- 
giene. (Twenty-fourth  annual  re- 
port of  the  New  York  bureau  of  la- 
bor statistics  for  the  year  ended 
Sept.  30,  1906.  Albany,  1907,  p.  71- 
152.) 

Mortality  statistics  for  England  and  the 
United  States,  and  descriptions  of  health 
conditions. 

Stewart,  D.  D.  Lead  convulsions;  a 
study  of  sixteen  cases.  (American 
journal  of  medical  sciences,  Philadel- 
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Four  of  these  cases  were  of  occupational 
origin,  in  persons  who  handled  dyes  and 
paints. 

Stickler,  J.  W.  Hatters'  consumption. 
(New  York  medical  journal,  May  29, 
1886,  v.  43:  598-602.  Also  reprint.) 

Description  of  processes  and  effects,  with 
abstracts  of  letters  from  hatters'  societies, 
records  of  17  cases,  and  mortality  statistics. 

Diseases  of  hatters.     (Report 

of  the  Board  of  health  of  New  Jer- 
,sey,  1885-6,  Trenton,  1887,  v.  10:  166- 
188.) 

Describes  processes  and  sanitary  condi- 
tions of  workrooms  and  gives  statistics  of 
physical  condition  of  240  employees  in  hat 


394 


American  Labor  Legislation  Review 


factories  and  mortality  statistics  of  hatters 
in  Newark  and  Orange. 

Stickler,  J.  W.,  Lane,  F.  B.,  Stubbart, 
J.  B.  Diseases  of  workers  in  textile 
goods.  (New  Jersey  board  of  health, 
twelfth  annual  report,  1888,  p.  159- 
178.) 

Describes  processes,  and  gives  table  show- 
ing results  of  inquiry  into  diseases  acquired 
since  entering  mill. 

Sullivan,  J.  W.  The  printer's  health. 
(Typographical  journal,  1903,  v.  23, 
no.  5,  p.  425-429;  no.  6,  p.  527-532. 
Reprinted,  condensed,  in  Commons, 
Trade  unionism  and  labor  prob- 
lems, p.  435-454.) 

Based  on  mortality  statistics  of  the  Inter- 
national Typographical  Union  and  of  local 
union  no.  6  (New  York  Citv),  with  des- 
criptions of  unhealthful  conditions. 

Sumner,  Helen  L.  History  of  women 
in  industry  in  the  United  States. 
(Report  on  condition  of  woman  and 
child  wage-earners  in  the  United 
States,  6ist  Cong.,  2d  sess.,  Senate 
doc.  645,  v.  9.  Health  in  textile 
factories,  p.  100-108.) 

Mainly  on  health  of  Lowell  factory  women 
before  1880. 

Taylor,  G.  R.  The  Chicago  industrial 
exhibit.  (Charities  and  the  com- 
mons, N.  Y.,  1907,  v.  18:38-45.  Il- 
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Popular  account,  with  reference  to  san- 
itary conditions  in  factories. 

Thayer,  Gordon.  Matches  or  men. 
(Everybody's  magazine,  April  1912, 
v.  26 : 490-498.) 

Popular   article   on  phosphorus  poisoning. 

Thompson,  T.  Kennard.  Pneumatic 
caissons.  (Scientific  American  sup- 
plement, Oct.  17,  1908,  v.  66:244- 
247.) 

Mainly  technical  description  of  caissons, 
but  contains  also  brief  account  of  caisson 
disease. 

Thompson,  W.  Gilman.  Classifica- 
tion of  occupational  diseases. 
(American  labor  legislation  review, 
June  1912,  v.  2,  no.  2:  185-191.) 

Occupational  diseases  of  mod- 
ern life.  (Journal  of  the  Maine  state 
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Occupational  poisoning. 

(Journal  of  industrial  and  engineer- 
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On  the  prevalence,  nature,  and  means  of 
mitigation  of  occupational  poisoning. 

Resume     of     the     importance 

and  prevalence  of  the  occupational 


diseases.  (Medical  record,  N.  Y., 
Feb.  3,  1912,  v.  81:201-202.) 

Introductory  outline  of  the  subject. 

Reporting  of  occupational  dis- 
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political  science,  New  York,  v.  2,  no. 
2:24-31.) 

Practical  article  with  sample  schedules 
and  history  cards. 

....... .Notes  on  the  caisson  disease. 

(Medical  record,  N.  Y.,  1894,  v.  45: 

I33-I.34-) 

Brief  discussion  with  description  of  sev- 
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Tracy,  Roger  S.  Hygiene  of  occupa- 
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Comprehensive  treatise  (1879)  with  clas- 
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Trask,  John  W-  A  digest  of  the  laws 
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Brief,  concrete  treatment  of  a  large  num- 
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(Medical  communications,  Massa- 
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With  special  reference  to  Massachusetts 
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Wilbur,  Cressy  L.  Notification  of  oc- 
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Brief,   popular   article. 

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Wilson,  James  C.  Chronic  lead  poi- 
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..Ventilation,  air  space,  humid- 
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cism of  existing  laws.  (American 
labor  legislation  review,  June  1911, 
v.  i,  no.  2:  110-112.) 

Urging  investigations  to  establish  stand- 
ards. 

Temperature  and  humidity  in 

factories.  (American  labor  legisla- 
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297-304.) 

Sanitary  dangers  of  certain 

occupations.  (Journal  of  the  Mass- 
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..Factory  sanitation  and  effi- 
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Discussion,  tables  and  chart  showing  de- 
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With  special  reference  to  Pennsylvania, 
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History  of  nine  serious  cases  of  phos- 
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406 


American  Labor  Legislation  Review 


trial  diseases,  and  amending  the  pre- 
vious order  of  May  22,  1907.  Lon- 
don, 1908.  4  p.  (Cd.  4419) 
....  Committee  on  compensation 
for  industrial  diseases.  Report  of  the 
departmental  committee  on  compen- 
sation for  industrial  diseases  [with 
Minutes  of  evidence,  appendices, 
and  index]  London,  Printed  for  H. 
M.  Stationery  off.,  by  Wyman  and 
sons,  limited,  1907.  2  v.  in  i.  diagrs. 
([Gt.  Brit.  Parliament.  Papers  by 
command]  Cd.  3495-3496). 
....  Committee  on  lead,  etc.,  in 
potteries.  Report  of  the  depart- 
mental committee  appointed  to  in- 
quire into  the  dangers  attendant  on 
the  use  of  lead,  and  the  danger  to 
health  arising  from  dust  and  other 
causes  in  the  manufacture  of  earth- 
enware and  china  and  in  the  pro- 
cesses incident  thereto,  including 
the  making  of  lithographic  trans- 
fers... [with  appendices  and  min- 
utes of  evidence]  London,  Printed 
for  H.  M.  Stationery  off.,  by  J. 
Truscott  &  son,  ltd.,  1910.  3  v.  in  1. 
plates.  ([Parliament.  Papers  by 
command]  Cd.  5219,  5278,  5385) 
....  Dangerous  trades  (anthrax) 
committee.  Report  of  the  Depart- 
mental committee  appointed  to  in- 
quire into  the  conditions  of  work  in 
wool-sorting  and  other  kindred 
trades.  London,  1897.  35  p.  (Cd. 
8506) 

....  Dangerous  trades  (anthrax) 
committee.  Report  of  the  Depart- 
mental com'mittee  appointed  to  in- 
quire into  the  conditions  of  work 
in  wool-sorting  and  other  kindred 
trades.  London,  1897.  35  p.  (Cd. 
8506). 

....  Dangerous  trades  committee. 
Reports  of  the  Departmental  com- 
mittee appointed  to  inquire  into  and 
report  upon  certain  miscellaneous 
dangerous  trades...  London,  1898- 
99-  3  v.  (Cd.  8522,  9073,  9420,  9509). 
....  Treaties,  etc.,  1901-1910.  (Ed- 
ward VII.)  Accession  of  the  Unit- 
ed Kingdom  to  the  International 
convention  signed  at  Berne,  Sep- 
tember 26,  1906,  prohibiting  the  use 
of  white  (yellow)  phosphorus  in 
the  manufacture  of  matches.  De- 
cember 28,  1908  .  .  .  London 
[1909]  8  p.  (Treaty  series  no.  4, 
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4o8 


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Das  Institut  fur  Gewerbe- 

hygiene  zu  Frankfurt  am  Main... 
Frankfurt  a.  M.,  1910.  72  p. 

Mitteilungen  des  Institutes 

fur  Gewerbehygiene  zu  Frankfurt 
a.  M.  Beiblatt  zur  Sozial-technik. 
i. —  Berlin,  A.  Seydel,  1910 — 
monthly.  Issued  also  with  Sozial- 
technik. 

Programm  des  Kursus  fur 

Unfallheilung  und  Gewerbekrank- 
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Tatigkeitsbericht. . .  1910 — 

Frankfurt  am  Main,   [1911 — 

International  association  for  labor  leg- 
islation. Deux  memoires  presentes 
aux  gouvernements  des  etats  indus- 
triels  en  vue  de  la  convocation  d'une 
Conference  internationale  de  pro- 
tection ouvriere.  Publics  par  le  Bu- 
reau de  1'Association  internationale 
pour  la  protection  legale  des  tra- 
vailleurs.  Paris  [etc.]  Berger-Lev- 
rault  &  cie,  1905.  44,  32,  [45]  -49 
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gale des  travailleurs,  no.  4) 

Les   industries   insalubres. 

Rapports  sur  leurs  dangers  et  les 
moyens  de  les  prevenir,  particu- 
lierement  dans  1'industrie  des  allu- 
mettes  et  celles  qui  fabriquent  ou 
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mai  1905)  [n.p.,  1905]  128  p. 

2d,  Bern,  1906.     Actes  de  la 

Conference  diplomatique  pour  la 
protection  ouvriere  reunie  a  Berne 
du  17  au  26  Septembre  1906.  Berne, 
Impr.  Staempfli  &  cie,  1906.  165  p. 
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45  vom  7,  November  1906.  Contents. 
— Documents  preliminaries. — Proces- 
verbaux  des  seances  plenieres  et  des 
seances  de  commission. — Textes 
adoptes  par  la  Conference:  Conven- 
tion internationale  sur  1'interdiction 
du  travail  de  nuit  des  femmes  em- 
ployees dans  1'industrie.  Conven- 
tion internationale  sur  1'interdiction 
du  phosphore  blanc  (jaune)  dans 
1'industrie  des  allumettes. 


International  congress  of  first  aid  and 
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1908.  Bericht  iiber  den  Internation- 
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juni  1908.  Hrsg.  von  der  kongress- 
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Meyer...  Berlin,  August  Hirsch- 
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International  congress  of  hygiene  and 
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Compte  rendu  du  Congres...  Brux- 
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Vol.  2-8:  "Premiere  division. — Hy- 
giene"; v.  9:  "Deuxieme  division. — 
Demographic."  Contents. — t.  I. 
Compte  rendu  du  Congres. — t.  II. 
Section  I.  Bacteriolpgie. — t.  III.  Sec- 
tion 2.  Hygiene  alimentaire. — t.  IV. 
Section  3.  Technologic  sanitaire. — 
t.  V.  Section  4.  Hygiene  industrielle 
et  professionnelle. — t.  VI.  Section  5. 
Hygiene  deS  transports  et  communi- 
cation— t.  VII.  Section  6.  Hygiene 
administrative. — -,.  VIII.  Section  7. 
Hygiene  coloniale. — t.  IX.  Demog- 
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I4th,  Berlin,   1907.-     Bericht 

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fer  i  industrielle  virksomheder. . . . 
Kobenhavn,  1907.  12  p.  (Dansk 
forening  for  arbeiderbeskyttelse.  [2. 
hfte.]) 

Schneider,  H.  Gefahren  der  Arbeit  in 
der  chemischen  Industrie;  hrsg. 
vom  Verband  der  Fabrik-Arbeiter 
Deutschlands.  Hannover,  Volks- 
buchhandlung,  1911. 

Schuler,  F.  and  F.  H.  Whymper.  Fa- 
brikhygiene  und  Fabrikgesetzge- 
bung.  Deutsche  Vierteljahrsschrift 
fur  oeffentliche  Gesundheitspflege, 
1888,  v.  20:  283-302. 

Schut,  P.  Bakker.  Bericht  uber  das 
Verbot  des  Gebrauches  von  Bleifar- 
ben  und  uber  die  Versuche  mit  blei- 
freien  Farben  in  den  Niederlanden 
. . .  Amsterdam,  Drukkerij  Plantijn, 
1908.  21  p.  (Nederlandsche  ver- 
eeniging  voor  wettelijke  bescherm- 
ing  van  arbeiders,  section  der  In- 
ternationalen  Vereinigung  fiir  ges- 
etzlichen  Arbeiterschutz) 

Schweizerische  Vereinigung  zur  F6r- 
derung  des  internationalen  Arbei- 
terschutzes,  Bern.  Eingabe  des 
Vorortes  an  die  Kantonsregierungen 
und  Gemeindeverwaltungen  vom 
Marz  1905,  betreffend  Ersetzung  des 
Bleiweisses  im  Malergewerbe  durch 
bleifreie  Farben.  Bern,  Buchdruck- 
erei  Beukomm  &  Zimmermann, 


[1905]  7  P-  (Its  [Veroffentlichun- 
gen]  Hft.  10.) 

Memoire  du  Vorort  addres- 

se  aux  gouvernements  cantonaux 
aux  administrations  communales  en 
date  du  10  mars  1905  concernant  la 
substitution  dans  le  metier  de  la 
peinture  en  batiments  de  coleurs 
sans  plomb  a  la  ceruse.  Berne, 
Impr.  cooperative  de  1'union,  [1905]. 
8  p.  (Association  nationale  pour 
1'avancement  de  la  protection  inter- 
nationale  des  ouvriers.  [Publica- 
tions] fasc.  no.  10.) 

Scott,  A.  Industrial  diseases.  Prac- 
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Sejournet.  fitudes  d'hygiene  profes- 
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Shann,  G.  The  influence  of  occupation 
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No.  10 :  Proceedings   of  the  First  National  Conference   on   Industrial  Dis- 
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Introductory  Address,  Henry  W.  Farnam. 

Importance  of  Industrial  Hygiene,   Henry  Baird  Favill. 

Phosphorus   Poisoning   in   the   Manufacture   of   Matches,  John  B.  Andrews. 

Occupational  Diseases  in  Illinois,  Chas.  R.  Henderson. 

Lead  Poisoning  in  Illinois,  Alice  Hamilton. 

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Lead    Poisoning   in    Illinois,    Alice    Hamilton. 

Neurasthenia  in   Garment   Workers,    Sidney   I.    Schwab. 

Industrial   Diseases  in  America,   Frederick  L.   Hoffman. 

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under  the  direction  of  John  R.   Commons. 
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No.  14:  (American  Labor  Legislation  Review,  Vol.  I,  No.  3.)     Review  of 

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and  Reporting  of  Industrial  Injuries. 

Scientific  Accident  Prevention,  John  Calder. 

Practical  Safety  Devices,  Robert  J.  Young. 

The  Wisconsin  Industrial  Commission,  John   R.   Commons. 

Safety  Inspection  in  Illinois,  Edgar  T.  Davies. 

Tke  Massachusetts  Board  of  Boiler  Rules,  Joseph  H.  McNeill. 

The  Beginning  of  Occupational  Disease  Reports,  John  B.  Andrews. 

Accident  Reports  in  Minnesota,  Don  D.  Lescohier. 

Advantages  of  Standard  Accident  Schedules,  Edson  S.  Lott. 

A  Plan  for  Uniform  Accident  Reports,  Leonard  W.  Hatch. 

No.  16:  (American  Labor  Legislation  Review,  Vol.  II,  No.  i.)     Proceedings 

of  the  Fifth  Annual  Meeting,  1911. 

Relation  of  State  to  Federal   Workmen's   Compensation  and  Insurance  Legislation. 

Introductory  Address,  Henry  R.  Seager. 

Compulsory  State  Insurance  from  the  Workman's  Viewpoint,  John  H.  Wallace. 

Accident    Compensation    for    Federal    Employees,    I.    M.    Rubinow. 

Constitutional   Status   of   Workmen's   Compensation,    Ernst   Freund. 
Uniform    Reporting    of    Industrial    Injuries: 

Report  of  Special  Committee  on  Standard  Schedules,  Leonard  W.  Hatch. 
Unemployment    Problem    in    America: 

Introductory  Address,  Charles  Nagel. 

Unemployment  as  a  Coming  Issue,  William  Hard. 

Experience  of  the  National  Employment  Exchange,   E.   W.   Carpenter. 

Recent  Advances  in  the  Struggle  Against  Unemployment,  C.   R.  Henderson. 
Safety  and   Health   in   the   Mining   Industry: 

Introductory  Address,  Walter  Fisher. 

Work  of  the  United  States  Bureau  of  Mines,  J.   A.  Holmes. 

Occupational  Diseases  in  the  Mining  Industry,  S.  C.  Hotchkiss. 

A  Federal  Mining  Commission,   John   R.   Haynes. 

No.  17:   (American  Labor  Legislation  Review,  Vol.  II,  No.  2.)     Proceedings 
of  the  Second  National  Conference  on  Industrial  Diseases,  1912. 


Life  let  us 
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